The Most Important Exercises

No fitness program is complete without core-strengthening exercises.  It’s the most important set of exercises in your entire routine.  A strong and well-balanced core allows you to do all your other exercises and get the most benefit out of them.

The Heart of the Core – the deep muscles of the transverse abdominals – wraps around the trunk like a corset.  It attaches the lower ribs, diaphragm, and lumbar spine to the hips In effect, it ties the rib cage and upper body to the pelvis and lower body.  It keeps you firmly “connected.”  It also stabilizes the body, protects the spinal column and provides support for the various physical activities we perform.
Read about the importance of strengthening the core muscles in Back Surgery – Avoid the Nightmare.

Major muscles of the core are shown above.  They include muscles of the pelvic floor, lower back and diaphragm (not shown).  When you do your core exercises, these are the muscles strengthened. 

A. Serratus anterior;  B. Transverse abdominal;  C. Internal oblique;  D.  External oblique;  

E.  Aponeurosis of the ext. oblique;  F.  Linea alba;  G. Tendinous insertion;  H.  Rectus abdominus.

Think Twice About Spinal Fusion Surgery

If you’re thinking about having back surgery, you should know that  spinal fusion surgery is a risky procedure that’s most likely to fail. It has failed so often, it has become associated with a special, diagnostic category – Failed Back Surgery Syndrome  (FBSS).  This means that the vertebral bones operated upon have failed to heal, solid fusion has failed to occur, back pain will continue unrelieved and, more often than not, you’ll need another operation.

 

Many knowledgeable physicians and surgeons have studied the issue.  What do they have to say about the risks vs. benefits of spinal fusion surgery?

“It’s amazing how much evidence there is that fusions don’t work, yet surgeons do them anyway.”  Sohail Mirza, MD, Chairman, Department of Orthpaedics, Dartmouth Medical School, Hanover, New Hampshire.

“... among patients having surgery for degenerative disc disease, those who had spinal fusion surgery had nearly twice the rate of reoperations compared to those who did not have surgery ...”  Richard A. Deyo, MD, MPH, University of Washington, School of Public Health and Community Medicine.

"This procedure is offered to improve pain and function, yet objective outcomes showed increased permanent disability, poor return to work status, and higher doses of opioids."

Dr. Trang H. Nguyen of University of Cincinnati College of Medicine.

Don’t let your back pain drive you to the spine surgeon.  Lumbar pain is a self-limiting condition and you’ll eventually recover without any treatment whatsoever.  If the pain persists after 6 weeks, find a good physical therapist.

The American Academy of Family Physicians recommends conservative treatment for those who suffer chronic low back pain.  This includes restricted bed rest (not to exceed two days), continued activities, medication and rehabilitation (which can include chiropractic care).  Read all the details about the risks and complications of back surgery and the superior benefits of conservative treatment in my new book (soon to be published) Back Surgery – Avoid the Nightmare by Benjamin Goode.

Stiff Neck and Poor Posture

Poor postural habits – rounded upper back with head thrust forward – produces a state of constant muscular tension, usually associated with pain, headache and limited range of motion. This uncomfortable position is a constant source of pain and, if not corrected, can lead to permanent shortening of the sternocleidomastoid muscles and the muscles in the back of the neck (i.e., splenius, semispinalis and cervical erector spinae).  In other words, poor posture can lead to anatomical changes which, in turn, contribute to continued poor posture.

The sternocleidomastoid and deep scalene muscles of the neck are of major importance in rotating the head to the left and right.  Tightness and shortening of these muscles can severely restrict our ability to turn our heads.  The muscles in the back of the neck (i.e., splenius, semispinalis and cervical erector spinae) play the important role of extending the neck and stabilizing the head as it turns.  These muscles are under constant tension as they try to maintain the upright position of the head in spite of the spinal imbalance caused by faulty posture.

When chronic neck pain and restricted range of motion is the result of tight, shortened neck muscles, the best, conservative treatment should include repeated, brief periods of mild stretching combined with the application of moderate heat and massage.

In my next blog post, I’ll suggest a few simple exercises you can do each day that will relax and lengthen your neck muscles .  If you do the exercises regularly, you can increase the range of motion of your head and neck.  Stay tuned.

3 Simple Steps to a Younger Appearance

You can do a lot to correct that round-back, hunched-over posture that reduces your height and makes you look older than you really are.  All it takes are three simple stretching exercises added to your daily routine.  The following exercises are designed to improve muscle balance and restore good posture.  Do them each day for three weeks and you’ll notice marked improvement in your appearance and – attitude.

1. Posterior Neck Stretch

Lie on your back, bend your knees and keep your feet flat on the floor; with your elbows bent, move your hands up beside your head; tilt the pelvis to flatten your low back.  Press your head back with chin in to flatten the curve of the neck.  This exercise will help to loosen and lengthen the muscles behind the neck.

2. Shoulder Stretch

With your knees bent and feet flat on the floor, tilt your pelvis upward to flatten the arch of the low back.  Place both arms overhead and reach (horizontally) keeping elbows straight.  Move your outstretched arms as close in to the sides of your head as possible.  This maneuver will help to elevate the chest and strengthen the muscles of the shoulders and thoracic spine.

3. Wall-Standing Stretch

Stand with your back against the wall and with your heels three inches from the wall.  Place the back of your hands against the wall beside your head while keeping your elbows touching the wall.  Press your back against the wall to flatten the arch of the low back.  Move your arms slowly overhead (in a slight diagonal direction) maintaining contact with the wall.  For the best results, reach a little bit higher each time you do this exercise.  (This exercise can also be done from a sitting position using a chair or low stool pushed up against the wall.)

Exercises to Avoid

The following exercises are counter-productive and may be injurious:

• Lying on the back and raising both legs at the same time;
• Lying on the back and coming up to a sitting position with legs held down;
• Lying on the back with weight on upper back and doing “bicycle’ exercise;
• Standing or sitting with knees straight and bending forward to touch toes;
• Raising the trunk from a face-lying position.

These exercises places excessive stress on the lumbar spine, create muscle imbalance and tend to shorten the hip flexor muscles.

Set the Core – Prevent Low Back Pain

We all go to the gym essentially for the same reason – to make changes in our physical lives.  We want exercises that will help us lose weight, build muscle or improve our general health and appearance.  However, as we reach our 40s and 50s, there are physical and functional changes that occur within our bodies that interfere with the improvements we want to make.   These changes are part of the aging process we all have to contend with.

As we grow older, we become more vulnerable to certain types of injury. Our intervertebral discs dry out.  They become brittle and fractured.  The soft nucleus of the disc is forced out of its normal position and sometimes impinges upon spinal nerves.  Spinal ligaments become calcified and lose their elasticity.  Osteoarthritis of spinal joints can constrict spinal nerves and cause sciatic pain.  And even with relatively minor injuries, our recovery time is longer.

These changes occur in all of us – in some, they are mild, in others, severe.  The pain caused by these conditions varies considerably from one individual to the next.  A severe osteoarthritic spinal joint might cause niether pain nor discomfort in one individual while a much less severe condition can cause excruciating, debilitating pain in someone else.  A minor muscle strain, for example, can produce a painful spasm that can immobilize the entire body.

One of the most common injuries experienced by the older exerciser is a strain of the muscles that support the lumbosacral joint. Spasm, pain and disability are the usual consequences. Here’s a technique you can use that will protect your lumbar spine against sprains and dislocations (destabilization) during your normal exercise routine.  It’s called The Valsalva Maneuver.

The Valsalva maneuver is the attempt to force air out through a closed airway (glottis).  Power lifters and body builders use this technique to support the lumbar spine.  They call it “setting the core.” The maneuver increases intra-thoracic and intra-abdominal pressure adding rigidity to the lumbar spine and keeping it in alignment throughout the exercise.  You can master this technique with a little practice. 

First, take a deep breath and hold it for 3 or four seconds.  Now try to exhale  – but keep your airway closed.  You’ll feel your abdominals and paraspinal muscles tighten.  Now, open your airway and exhale normally.  Next, repeat this maneuver but this time release about 50% of the air you inhaled.  After 3 or 4 seconds, exhale normally.  Finally, do the same thing, but release another 20% of the air you took in.  You’re now left with about 30% of intra-abdominal pressure – sufficient to protect your lumbar spine during almost any exercise.  Remember – the stronger your core muscles are, the greater the protection you’ll get.  Don’t worry about the adverse effects of holding your breath.  You’ll find that as you gain more control over your “abdominal corset” you’ll be able to breath

normally – inhaling on exertion and exhaling as you complete the exercise.

Almost all of the exercises used in a strength-training program require a balanced, stable lumbar spine for support.  When you do any of these exercises, do them correctly. But before you do them, think kindly about your back ..... set the core.

Total Disc Replacement – A Questionable Alternative

As an alternative to spinal fusion, your surgeon may offer a total disc replacement (TDR) for relief of your back and leg pain.  A TDR procedure involves removing the degenerated disc and replacing it with an artificial disc implant.  After the implant has been inserted between the vertebral bodies, normal disc height is restored and motion in the joint is preserved.  This intervertebral joint motion is thought to create "normal balance and a more natural spinal function."  It is also theorized that the artificial disc slows down degeneration of adjacent spinal segments.  This all sounds great until you examine some of the critical details of how the disc works in practice.

Most complications in TDR surgery occur as the result of inaccurate positioning of the artificial disc.  If the surgeon selects too large an implant and places it too far forward in the disc space, the entire implant tends to migrate farther forward, well beyond the the margin of all the other spinal discs. (Migration is the movement or shift in position of an object within the body.  It's a constant risk with any implant.)  This forward position of the implant can puncture the large blood vessel that lies directly in front of the lumbar spine.  The possibility of this one, life-threatening complication is enough to make you think twice about having an artificial disc implanted.

Low Back Pain – The Price of Poor Posture

Do you remember when your fifth-grade teacher scolded you for slouching?  “Stand up straight, young man – and take your hands out of your pockets.”

Sounds like she was giving you some good, therapeutic advice.  If she were a physical therapist, she might have said, “Flatten out that kyphotic-lordotic curve, adduct those shoulders and, while you’re at it, add some posterior tilt to your pelvis.”  If you had followed that advice, it might have helped you avoid many episodes of painful, low back pain. 

There’s no doubt that faulty posture is a significant cause of low back pain.  Thankfully, it’s a condition that can be corrected with a few special exercises and some new, postural habits.

Ideal Posture

In the ideal posture, viewed from the side (A), the normal spine assumes a gradual, S-shaped curve – convex at the top (kyphosis) and concave at the bottom (lordosis).  The head is centered over the cervical spine and not tilted or rotated in any way.  Remember, the position of your head and neck will be affected by the conformation of your upper back.  If you allow your upper back to slump into a rounded, “hunched” position, your head will be thrust forward and downward into an increasingly uncomfortable position (B). 

The pelvis is in a neutral position – crest of the ilium directly positioned over the hip joint.  The forward part of the ilium is in vertical alignment with the pubic symphysis (A).  

Kyphotic-Lordotic Posture

In B, the S-shaped curve is exaggerated.  The kyphotic curve of the upper back is pronounced and the head and neck are forced forward.  Weakened abdominal and spinal muscles allow the pelvis to tip forward and increase the lordotic curvature. This adds strain to the lower back.

Corrective Exercises

Add the following exercises to your daily routine. If you’re overweight, modify your diet. Excess body weight tends to increase lordotic curvature and add considerable strain to the lumbosacral joint.

Upper Body

• Mild stretching and then strengthening of the muscles behind the neck (extensors) will help you establish a more erect position of the head.
• Strengthen the thoracic spine extensors (upper back) to elevate the chest.
• Add deep breathing exercises to your daily routine.  This will help stretch the intercostals and expand the chest.
• Stretch the adductor muscles of the shoulder and pectoralis minor to help bring the shoulders back to a more normal position.

Lower Body

• Strengthen the muscles of the low back.
• Strengthen abdominal musculature with posterior, pelvic tilt exercises.
• Avoid sit-ups.  They shorten the hip flexors and increase lordosis.
• Temporary use of a corset or brace can relieve the strain on abdominal muscles as you train yourself to stand, walk and sit in a more erect position.

The trainer at your gym should be able to show you the proper exercises to achieve these goals.