by Dr. Paul Williams, PT, DPT

​I wanted to preface this article by saying that in no way am I trying to point my finger at any one style of aikido or teachers. Aikido is a vast cornucopia of differing styles that emphasize one or more principles that make them unique. In my experience, there seems to be greater diversity within a single style of aikido than between other seemingly divergent styles. Case in point, I have always practiced Iwama aikido but there isn’t much Iwama aikido on the east coast. In order to broaden my horizons, I’ve practiced quite a bit with students of Yamada Sensei, Kanai Sensei, and Saotome Sensei. After moving to California and being exposed to numerous Iwama style aikido dojos, I can tell you that style is largely predicated on the teacher’s personality, body type, exposure to their teacher, and experience in other martial arts.
In my experience, one thing that is common to all styles of aikido is back pain. Back pain and especially lower back pain are the most common injuries and chronic conditions that I have heard of and experienced personally in aikido. It’s not only common in our martial art but also in the general population. According to the Journal of American Medical Association, in 2013 low back and neck pain accounted for 87.6 billion dollars spent in healthcare and about 30% of people in the United States have had low back pain in their life (Joseph L. Deleman & Ranju Baral, 2016). My focus here is to examine the reason why back pain seems so prevalent in aikido and what to do to stop it.
This topic is of vital interest to me because I have been dealing with lower back pain most of my adult life. I have what’s called spina bifida occulta. Some of you may have heard of spina bifida which is a horrible condition that’s caused by genetics and lack of folic acid intake during pregnancy. This often results in the spinal column failing to fuse during gestation and leads to all kinds of complications like paralysis, incontinence, and a shorter life span to name a few. I am very fortunate in that I have a very mild form of this condition. My spinous process in my lower back formed but not fully. As a result of this condition, it’s typical for people like me to have back pain that is more severe than most.
Since I was twenty years old, I’ve been chasing a cure or a working treatment. I’ve done massage, Rolfing, chiropractic, acupuncture, inversion tables, yoga, reiki, core exercises, swimming, aquatic therapy, and much more. This search led me to physical therapy school where I received my doctorate and a better understanding of my condition. It was here that I began my journey in discovering what works for me and I’d like to share this painfully acquired knowledge.
So, let’s begin with posture. Incorrect posture can lead to lower back pain (Smith, Harrison, & Straker, 2008). Therefore, posture is the best place to start when trying to mitigate lower back pain without getting into external forces. This begs the question. What is good posture? Well, the illustration below shows that a proper posture uses the plumb line dissecting the body from the sagittal (side) view starting at the ear lobe and moving vertically down to just the front of the ankle. In this posture, there is a minimum amount of compressive and shear forces acting on the spine when standing. This is key for spinal health and to reduce the risk of low back pain. As you can see, the head is supported by the hips and hips are supported by the stance or base of support as we like to call it in physical therapy. 

​​Now I want to share something that may be shocking to some. The nursing profession is the most dangerous profession for the lower back. Work related low back pain is the highest for nurses among all professions in acquiring lower back disorders and physical therapists are just under them (Vieira & Kumar, 2009). It shouldn’t be surprising then when one looks at all that a nurse and a physical therapist does in a given day at the hospital. Transferring a patient from bed to chair, bed to trolley, chair to trolley, trolley to bed, and rolling patients side to side are just a few examples exposing nurses and physical therapists to dangerous postures and actions.
 According to the National Institute for Occupational Health and Safety, the limit for compressive forces on the spine is 3,400 N forces (Vieira & Kumar, 2009). Some of the compressive forces for transfers listed above have been recorded to be as high as 14,493 N (Vieira & Kumar, 2009). That’s bonkers to put it in professional terms! These transfers at times include bending the trunk forward at about 50% of trunk range of motion with pulling, lifting, or pushing a patient in space. According to research, the effects of these loads accumulate over time on the structures of the lower back and may lead to dysfunctions later in life (Vieira & Kumar, 2004).
So that’s an extreme example telling how forward postures and external loads are detrimental to the lower back. Of course, some of you might be thinking, “Hey, I’m not bending over that far and lifting dead weight while I’m practicing aikido!”. However, some of you may relate to this in your aikido practice depending on your training partner. I’ll concede that this is the worst possible scenario. So, let’s look at another study that measured compressive and shear forces along with musculoskeletal activity with just a 13 degree bend forward from the hips with a straight back and no external load. For a visual, look at the picture below from the study to see how little 13 degrees of anterior translation looks like in picture A.

​According to the study, this forward posture increased intervertebral compression 92% at L5-S1 and increased shear stress 609% (Harrison, et al., 2004). Another point to make is that muscular activity without external forces are the largest contributor to intervertebral loads and stresses (Harrison, et al., 2004). These mere 13 degrees increased back extensor muscle loads to 942% from 8.2% (Harrison, et al., 2004). Are you getting the picture? The further forward your posture becomes outside your base of support the more exponential stress you put on your spinal structures. Now imagine striking a bokken or jo at full force and stopping it parallel to the ground with a forward lean. Mass multiplied by acceleration equals a lot of force on the lower back. For further illustration of this relationship, take a look below at how lifting a 20 lbs. box can increase your vertebral load at different positions.

​By looking at all of this, one might be wondering if practicing aikido is at all safe. Well, it is a martial art after all and nothing worthwhile is completely safe. There is always a benefit to risk calculation that we all must accept when doing anything as physically taxing as aikido no matter what the style. With that in mind, I think the best approach is to ask how can we minimize that accumulated load over time in order to allow us to continue practicing the art we all love so much? My first answer would be to look first at posture in our practice.
In most aikido dojos, hamni (half stance) is the most common stance in both weapons and open hand technique. My advice is to follow the principle of the plumb line in this position. As shown in the plumb line picture above, proper upright posture shows that the head is supported by the hips and the hips are supported by the feet. Try to mimic this as much as possible in your hamni stance. The one noticeable difference is a slight tilt forward of the upper torso. This is not a problem due to the fact you are still supported by the front foot in hamni. In physical therapy we call this an “active stance”.
To test yourself, take a picture of your hamni stance from the side view and draw a vertical line from your ear lobe all the way down to the ground. This can also be done easily with a friend placing a jo vertically on the ground lining it up with the ear. If the plumb line does not end up between your feet, then you are not supported by your base of support and you are exposing yourself to unnecessary and potentially dangerous shear and compressive forces on the spine. Below, are some good examples of postures that I think one ought to model after in aikido. 

​​One of the main reasons I moved to California was to see if I could change my luck with my lower back. I noticed from the day I met Hoa Newens Sensei that his aikido could help. I began to notice, by analyzing his posture, that he was very much in alignment and balanced while demonstrating techniques. My theory was that this possibly came from his practice of tai chi and qigong. After taking a few of his tai chi classes, I noticed a huge shift in how I held my hips and back in space. I also had a reduction in pain when I applied that posture in my aikido practice. In fact, my experience was backed up by research showing the efficacy in reducing low back pain with tai chi interventions (Hall, Maher, Lam, Ferreira, & Latimer, 2011).
This is great news for aikidoka because tai chi does not entirely get rid of forward postures, but it does teach the importance of concentrating on maintaining a center axis and activating the deep core muscles like the transverse abdominus (TA) via slow movements coordinated with breath. This muscle is incredibly important in treating lower back pain in physical therapy because it synergistically activates the multifidi of the lower spine thus protecting the lower back from shear and compressive forces (Carolyn A. Richardson, et al., 2002). It is so powerful and strongly connected to the lumbar spine that a very strong contraction of this muscle has been documented to avulse the transverse process of the spine (Barker PJ, 2004). In addition to its strong corset like action, the TA protects the lower back by reducing the over activation of the low back extensors that can also cause lower back pain (Carolyn A. Richardson, et al., 2002).
 That same study also showed that activation of the transverse abdominus decreases the laxity of the sacroiliac (SI) joint by facilitating a “close packed” position (Carolyn A. Richardson, et al., 2002). So what is a “close packed” position? It is the position and alignment of the joint that allows the most stability and joint congruency where the ligaments are maximally tight and accessory motion is minimized. This allows for any static force acting upon it to be transferred through the joint most efficiently and safely without harm to the joint itself. So, when you contract your TA the sacroiliac joint tightens to this close packed position allowing any ground reaction forces or external forces to safely pass through your center without harming the lumbar spine or the SI joint. I have found this to be very helpful in weapons class. In the past, I typically had a lot of lower back pain after striking the bokken for an hour. The lumbar spine was taking the brunt of both the ground reaction forces and the external force of the strike. Ever since I included activating the TA with a more upright posture, I no longer have this problem.
Luckily, activating the TA is very easy to do. All one must do is forcefully breath out and draw in the belly button. Some of you may already do this with kiai (breath shout) in your training. This creates a little posterior pelvic tilt because you co-contract other deep muscles of the abdomen that tilt the pelvis in this direction. That’s it! You can even do this right now as you’re reading. This action will create a deep muscle corset that will help protect your lower back.
When implementing TA activation and maintaining a more upright posture one can create a pillar of stability. But be mindful in your self-correction. In the beginning of working on posture, one must also be cautious to avoid over activating the lumbar extensors. You must relax the muscle around the lumbar spine and notice a very slight tuck of the pelvis when activating the TA. However, too much of a posterior pelvic tilt and you’ve created lumbar flexion. But don’t worry, one cannot lose the lumbar curve with just a posterior pelvic tilt (James W Day, 1984).

​ ​ The trick to avoid over compensation of tucking in the pelvis is alignment into a more neutral lumbar spine that promotes a happy medium between the natural curve of the lumbar spine and a slight posterior tilt of the pelvis. If you are like me and you’ve spent years of practice in hyperextension of the lumbar spine and anterior tilt of the pelvis with the head being positioned over the front foot, then be very mindful of over correction. The tendency is for the pendulum to swing in the opposite direction especially for those that are hypervigilant in their training.
Having a good posture, activating the TA, and exploiting the internal power provided by a close packed position of the SI joint are in my view the most important things one can do to prevent low back pain in aikido. In order to further understand the importance of close packed positions, think about one of the external expressions of kokyu. The position of the wrist involves extension and radial flexion actions that tightly align all the carpal bones, capsules, and ligaments as if they were tightly screwed in. The illustration below will help you understand these actions. To show how it relates to aikido, here you see O-Sensei practicing his kokyu on a tree and Morihiro Saito Sensei demonstrating morotedori kokyuho. One can see this exact position of the wrists with O-Sensei poised in preparation on making contact with a tree and Saito Sensei using kokyu to enter for a blend in kokyuho.

​​To further illustrate how a close packed position can transfer forces, I’m reminded of a story Mark Larson Sensei told me about his car accident. He was traveling on a rural road close to home one early evening with low visibility. The road had a deep drop down an irrigation ditch to his right. As he was going around a bend, a car was coming directly at him in his lane. He had three choices in 3 seconds: change lanes but run into oncoming traffic on his left; continue in his lane hoping the car would swerve back into their lane; or be run off the road to the right and possibly die. He chose the middle path.
However, the driver did not get back into their lane. As he readied for impact, he relaxed his body, put his head back on his headrest, hugged the right shoulder of the road, and placed his hands in 7’oclock and 5’oclock on the steering wheel. This is exactly the position of wrist extension and radial flexion (kokyu). The force of the impact went through the steering wheel and dissipated throughout his body. The energy from the collision was so strong that he broke the steering wheel in half. To the amazement of the EMT’s, he had no injuries to his hands or wrists! They asked, “What did you do?” He replied, “Kokyu-ryoku” (kokyu power). Luckily, he survived the car accident but suffered severe injuries sustained from the engine block wrapping around his right leg. Thankfully, he recovered almost fully and is still actively teaching aikido.
            Without the proper alignment of the wrists causing the transfer of forces through his body it is doubtful that Larson Sensei would be here today. Many fatal injuries from car accidents come from internal injuries sustained from the steering wheel and steering column. It is vitally important that we exploit the body’s natural ability to use close packed positions in order to maximize our ability to transfer either external or internal forces throughout our body safely and without injury. 
My hope in writing this article is to help others with back pain and to prevent it as well by sharing my personal and professional expertise. For me, chronic back pain has been both a curse and a blessing. It led me to where I am today and although I have been able to drastically reduce the frequency, duration, and intensity of my pain, on occasion it does come back for an unwelcomed visit. Yet, since I implemented this method a few years ago I have been able to train as hard and as often as I did in my 20’s. 
I absolutely love aikido and I see the good force it has been in my life, but I also see that the demographics in our art are shifting. We aren’t getting any younger and this should be an art that we can do well into the twilight of our lives. So, we must be vigilant in training and strengthening our bodies on a daily basis. I believe applying the methods covered in this article can be used as an effective tool in our arsenal to achieve this end.

By Dr. Paul Williams PT, DPT



Works Cited:

Barker PJ, B. C. (2004). Tensile transmission across the lumbar fasciae in unembalmbed cadavers: effects of transmission to various muscular attachments. Spine .
Carolyn A. Richardson, P., Chris J. Snijders, P., Julie A. Hides, P., Leonie Damen, M., Martin S. Pas, M., & Joop Storm, B. (2002). The Relationship Between the Transverse Abdominis Muscle, Sacroiliac Joint Mechanics, and Low Back Pain. SPINE, 399-405.
Hall, A. M., Maher, C. G., Lam, P., Ferreira, M., & Latimer, J. (2011). Tai chi exercise for treatment of pain and disability in people with persistent low back pain: A randomized controlled trial. Arthritis Care & Research.
Harrison, D. E., Colloca, C. J., Harrison, D. D., Janik, T. J., Hass, J. W., & Keller, T. S. (2004). Anterior Thoracic Posture Increases Thoracolumbar Disc Loading. Springer-Verlag .
James W Day, G. L. (1984). Effect of Pelvic Tilt on Standing Posture. Journal of the American Physical Therapy Association, 64:510-516.
Joseph L. Deleman, P., & Ranju Baral, P. M. (2016). US Spending on Personal Health Care and Public Health, 1996-2013. JAMA.
Smith, A. P., O’Sullivan, P. P., &; Straker, L. P. (2008). Classification of Sagittal Thoraco-Lumbo-Pelvic Alignment of the Adolescent Spine in Standing and Its Relationship to Low Back Pain . Occupational Health.
Vieira, E. R., & Kumar, S. (2004). Working Postures: A Literature Review. Journal of Occupational Rehabilitation.
Vieira, E., & Kumar, S. (2009). Safety analysis of patient transfers and handling tasks. BMJ Quality and Safety .