Spinal Hygiene: Part 2

Spinal Hygiene: Part 2 by Johnny Cooke

In Spinal Hygiene: Part 1 we discussed the importance of spinal hygiene to remedy or prevent back pain and to improve overall spine health. In Part 2, we will examine the architecture of the spine and how it’s 3 distinctly different levels all perform different functions. Let’s dive in…

The spinal column is comprised of 33 individual bones called vertebrae that are stacked on top of one another. Of these vertebrae there are 24 that are moveable, and each of them have bony protrusions called processes that serve as anchors for muscles, tendons, and ligaments. The actual joints of the spine are called facets of which there are 2 for every disc. These facet joints guide the motion that is available at each spinal level (more on this later). Between each vertebrae lie intervertebral discs comprised of outer rings of collagen and an internal nucleus. These discs support load between the vertebrae and allow for motion and shock absorption. 

The 24 vertebrae, their processes, their facet joints, and the discs, are divided into 3 categories according to their geography. Each of these 3 “levels” have unique architecture, and therefore unique function and available motion. The 3 spinal levels, from top to bottom, are the Cervical Spine, the Thoracic Spine, and the Lumbar Spine. 

The Cervical Spine is comprised of 7 vertebrae (C1-C7), the hyoid bone, and the manubrium of the sternum. It assumes a lordotic curve (C shape) as its neutral position. The Thoracic Spine is comprised of 12 vertebrae (T1-T12), the rib cage, and the lower sternum. It assumes a kyphotic curve (reverse C) as its neutral position. The Lumbar Spine is comprised of 5 vertebrae (T1-T5), and the Sacrum. It assumes a lordotic curve (C shape) as its neutral position. Looking at the spine from a side view, normal curvature of all 3 levels combined resembles a soft 'S' shape. When viewing the spinal column from behind, the spine will appear vertically straight. 

In addition to the unique curvature at each level, the size of each vertebrae and its processes, and the particular orientation of its facet joints, dictate the function and primary motion of each level . It is true that to some degree every level of the spine can flex, extend, and rotate. However, the percentage of contribution at each level to these motions should be predictable and purposeful to reducing unnecessary wear and tear. Below is a brief overview of the type of motion that each level best provides.

Cervical Spine; rotation at the Atlas (C1), and both flexion and extension at C2-C6. Interestingly, C2-C6 offer minimal rotation, and C7 acts as a base of support for the flexion and extension between C2-C6.

Thoracic Spine; T1-T12 offer the greatest amount of rotation of all 24 moveable vertebrae. T1-T12 offer moderate amounts of flexion and modest (if not minimal) amounts of extension due to large and inferior facing spinous processes.

Lumbar spine; L1-L5 are well suited for flexion and moderately capable of extension (forward and laterally). L1-L5 have minimal rotation due to its vertical facet joints and rely heavily upon the thoracic spine and the hips when rotating in space.

Right now, you might be asking why it is important to understand the architecture of the spine and its motion? Glad you asked… Understanding what the spine is intended to do and the types of forces it can favorably can produce or reduce, is critical to exercise selection and design. In essence, sound decisions about how to properly and safely train the muscles of the spine inherently require this knowledge. In an upcoming article we will identify some dos and don’ts of “core” training, taking into account everything that we have learned up to this point.

Exercise and Bone Density

Exercise and Bone Density by Michelle Amore

There is evidence that exercise not only stimulates bone growth in adults and the elderly, but also reduces the loss of bone mass associated with aging.  The type of stimulus used during exercise can directly effect bone mass, positively or negatively. While several methods of training can be used to increase bone mineral density (BMD), there are specific types of exercises, if executed regularly, that can have a positive effect on BMD. 

Osteoporosis is a disease of the bone that makes a person’s bones brittle, weak and more likely to break. According to the National Osteoporosis Foundation, approximately 10 million Americans have osteoporosis and another 44 million have low bone density, placing them at increased risk.  While hormonal changes and vitamin deficiencies aid in the cause of low BMD, a sedentary lifestyle and lack of weight bearing exercise also causes fragility and low T-scores.  T- scores are used to help identify whether you have normal bone mass, low bone mass (osteopenia), or osteoporosis.  When a T-score is -2.5 or below, you are diagnosed with osteoporosis. The lower your T-score, the greater your risk for fracture. Osteoporosis can also be diagnosed if you have had a fracture without trauma when you were older than 50.  Speak to your healthcare provider to decide when you should take a Bone Mineral Density Test.

Whether attempting to increase BMD or prevent osteoporosis, weight-bearing aerobic activity and strength and resistance exercises should be a regular part of your weekly workout regimen.  With an exorbitant amount of exercise options to choose from, it is important to prioritize activities that nudge bone forming cells, or osteoblasts, into action.

Weight-Bearing Aerobic Activities

Weight-bearing aerobic activities, or impact activities in which arms, feet, and legs are bearing the weight, that lead to improved bone mass include the following:

Stair Climbing

Jogging

Tennis

Dancing

Hiking

Hill Climbing

Walking, while advised for health maintenance, does not increase the loss of BMD as an isolated activity.  Walking/jogging must reach a level of intensity that creates high enough forces to stimulate bone mass.  

Strength and Resistance Training Exercises

Strength and resistance exercises are vital to the stimulation of osteoblasts and in limiting the reduction of BMD.  Benedetti and colleagues recommend high loads (70-90% of a maximum repetition) for 8-10 repetitions of 2-3 sets performed at least for 1 year, 3 times a week for 45-70 minutes per session.  Particular focus should be placed on exercises that stimulate the hips and spine to limit femoral neck and lumbar spine degradation.  A few exercises that can be beneficial to the development of bone mass, prioritizing the hips and spine, are the following:

Weighted Squats or Body Weight Squats

​​Hold a kettlebell, dumbbell in both hands at chest level and stand with your feet hip-width to shoulder-width apart. Stand tall and brace your core, then drop your butt back and down as you keep your chest up, sitting back onto your heels without shifting your weight forward onto the balls of your feet.

Video - Weighted Squat with Dumbbells at Shoulder

Video - Weighted Squat with Dumbbells at Sides

Body weight squats can be performed the same way but without holding extra weight.  Using a chair and proceeding to sit all the way down and stand all the way up is a great modification to a weighted squat. 

Video - Chair Sit-to-Stand/Chair Squat

Leg Press

Lower the weight under control until the legs are roughly 45 degrees or slightly below. Drive the weight back to the starting position by extending the knees but don't forcefully lockout. Repeat for the desired number of repetitions.

Video - Prime Fitness Leg Press

Step-ups

  • Stand up facing an elevated platform with your arms at your side.

  • Put your right foot on an elevated platform. Step on the platform and use your heel to lift the rest of your body up. Place the foot of your left left on the platform. 

  • Step down with your left leg controlling the movement as you descend. Return to a standing position by placing both feet next to each other on the ground.

  • Repeat this movement with the right leg for the desired number of times and then switch to your left leg.

Video - Step-ups

Latissimus Pull Down

  • Place your knees under the provided pads. Position the pads so that your thighs are not able to raise up off the bench.

  • Grasp the lat bar with a little wider than shoulder-width grip. This is the starting position. Note: Hand position and the plane of motion should be adjusted based on an individual's joint mechanics. 

  • Begin exercise by pulling your elbows out to the side and down while the bar travels down to your upper chest. Focus on using your lats to pull the bar down and not your arms.

  • Slowly reverse movement back to starting position.

Video - Wide Lat Pulldown

Video - Parallel Plane Lat Pulldown

Dumbbell Bent Over Row

  • Take a dumbbell in each hand.

  • Slightly bend your knees and bend over at the waist so that your chest is almost parallel with the floor.  Note: Spinal stabilization is required during this exercise to support the lumbar spine.  This can be achieved through core engagement or lying your chest against a support.  

  • Let the dumbbells hang in your arms and then pull them toward your mid-torso.

  • Lower the dumbbells back down to starting position.

Video - Bent Over Dumbbell Row

MODIFICATIONS

Video - Bench Supported Dumbbell Row

Video - Single Arm Supported Dumbbell Row

Additional exercise examples include hip extension, hip adduction, knee extension, hamstring curls, deadlifts, power cleans, military press, seated rows, back extension exercises, bench press, elbow flexion, wrist curl, reverse wrist curl, triceps extension, forearm pronation and supination, and so many more that can all be performed at prescribed levels of intensity to build bone.  

All exercise descriptions are listed with the assumption that repetitions will be performed.  Isometrically performing the exercising at 70-90% of maximum effort can be used rather than concentric and eccentric movements.  Isometric exercise consists of pushing or pulling at a given effort level with the absence of joint motion.  It is important to consult an exercise professional for individualized exercise prescription and guidance through a BMD program.


The Importance of a Healthy Heart Program

The Importance of a Healthy Heart Program by Aaron westbrook

Complexity defines the human body. Each organ, tissue, and cell has its own role to play. Our Cardiorespiratory systems are no different. Our hearts and lungs work tirelessly to shuttle oxygen, sugars, hormones, immune cells, and more through highways of arteries and veins. We survive and enjoy every part of life thanks to these pumps and tubes, and in return, all these systems require for optimal health is a little regular stimulation. Given the complexity of these systems, there are a lot of things that can go wrong if they are not adequately repaired or stimulated. Lack of physical activity can contribute to many different adverse health conditions. Heart, kidney, liver, and metabolic diseases; bone and muscle loss; increased risk of stroke, cognitive decline, and falling… The list goes on… 

So walk, run, strength train, cycle, swim, do whatever activity you like the most; all of these, in appropriate dosages, benefit the cardiorespiratory system. But now how can you find your appropriate level of training? PHP’s Healthy Heart program creates a streamlined and customized approach to starting, maintaining, and progressing your current cardiorespiratory training program. Our approach is simple and direct. Healthy Heart creates a partnership between you and your cardio coach to create clear, defined goals set by your exercise needs and baseline fitness levels. With your capacity for exercise, and our evidence-based approach to cardiorespiratory exercise training, we design a program that is fit to your needs, abilities, and schedule to build you a healthy heart. Your heart, and by extension the rest of your body, will thank you!

Spinal Hygiene

Spinal Hygiene by Johnny Cooke

Back pain is common in today’s world. According to Georgetown University back problems are among patients’ most frequent complaints to their doctors. Nearly 65 million Americans report a recent episode of back pain. Some 16 million adults — 8 percent of all adults — experience persistent or chronic back pain, and as a result are limited in certain everyday activities. Back pain is the sixth most costly condition in the United States. Health care costs and indirect costs due to back pain are over $12 billion per year. Etiology varies, some people have injuries or pathologies that requires a detailed intervention, others have general weakness and muscle atrophy that can be resolved with simple strengthening, and others still may be suffering from overuse and experiencing acute overtraining with the risk of becoming chronic. 

Whether a person is suffering frequent back pain, occasional back pain, or is taking steps to avoiding ever having back pain, there is one strategy that applies to every model. We call it Spinal Hygiene. Hygiene is the conditions or practices conducive to maintaining health and preventing disease. We practice hygiene everyday in a number of ways; dental care, fiber, probiotics, and fermented foods for gut-health, hand washing to avoid germs, and a multitude of other habits. In a world riddled with back pain, we are well served to care for our spine in the same manner and with the same good habits.

Let’s get down to it, what exactly is spinal hygiene? It is the daily upkeep of back health through activities that act as both recovery and prevention from predictable spine stressors and dysfunction. The exact prescription will vary from person to person, but there are a few basic exercises that have near universal application. For practical purposes we will lay out the ones that should be used daily to expand pain-free movement capabilities, prevent future back pain, and improve spinal stability and mobility.

Cat/Cow – Quadruped stance (kneel on the floor with your hands on the floor in front of you). Keep your hands shoulder-width apart and your knees directly below your hips. Inhale while curving your lower back and bringing your head up, tilting your pelvis up (spinal extension). Next, exhale and bring your abdomen in, arching your spine and bringing your head and pelvis down (spinal flexion). 

Cat/Cow Video

Perform daily for 20-30 gentle cycles, being mindful of slow and controlled motion and not to “push” at either end range.

Bird-dog – Quadruped stance (kneel on floor with your hands on the floor in front of you, and simultaneously raise the opposite arm and leg while maintaining the position of your trunk and spine aligned with the floor. Be mindful to raise the arm no higher than the shoulder and the leg no higher than the hip.

Bird Dog Video

Perform daily 1 set per side with an isometric hold of 5-45 seconds depending on your pain-free capabilities.

Unsupported sitting w/ Abdominal bracing – Sitting on the end of a bench with your hips at 90 degrees and hands placed slightly above your hip bones. Mindfully identify “good” posture with appropriate spinal curves. Next, while maintaining posture Brace the abdominal muscles by attempting to contract in a manner that will push your hands outward.

Exercise Video

Perform daily 1 set with 5-10 repetitions of bracing held for approximately 5 seconds.

Mindful walking – As simple as it sounds. While gently walking, be mindful of the spinal curves, stability, and the opposite arm and leg working together simultaneously. The goal is to tie together the previous exercises into an animated version.

Perform daily, post above exercises, for 5 minutes or as tolerated. This activity, like the others, should be performed with as much cognitive effort and physical. As we say around here, Train Smart!

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