endurance training
The S-shaped bridge

The spine connects the upper and lower parts of the human body

resistance training
Anatomy of the spine.

In order to better understand fitness and its mechanics, bodyLIFE-India has set out on a primer on human anatomy for the benefit of trainers and gym owners/managers alike. The first in a series of articles has been written with specific reference to the fitness culture and knowledge requirements in India. You are welcome to connect with us at [email protected]

The spine is basically a part of our skeleton which forms a solid bridge between our upper and lower body. Therefore, the spine allows us to stand upright, bend forward and sideways.

It also protects the spinal cord, which is a delicate bundle of nerves that connects the brain to the rest of our body. The signal sent by the brain through the spinal cord is what finally allows us to initiate any movement with our muscles. In effect, it also controls the functions of our muscles.

No wonder then that severe injuries to the spine can sometimes cause paralysis in other parts of the body and sometimes also organ failure. Therefore, keeping the spine strong, healthy and injury-free is vital if you, and people you train, want to live an active life.

The spine is made up of 24 small bones (vertebrae) that are stacked on top of each other and held together by ligaments, to create what is called the spinal column. Between each vertebra is a soft gel-like cushion called a disc, which helps absorb pressure and shock and also keeps the bones from rubbing against each other.

The spine is made up of three segments: the top cervical spine made up of seven vertebrae (C1 to C7), the middle thoracic spine consisting of 12 vertebrae (T1 to T12), and the bottom lumbar spine which is usually made up of five vertebrae (L1 to L5), but occasionally may have six of them.

The lumbar spine sits on top of the sacrum, which is a triangle-shaped bone that connects the spine to the big pelvic bone in the hip region. A normal spine will be shaped like the letter ‘S’. This shape allows for better distribution of load on the spine.

The cervical spine is much more mobile than both of the other spinal regions: think about all the directions and angles you can turn your neck. It sits below our skull and curves slightly inwards. The thoracic curves outward, and the lumbar curves inward. These curves are described by the terms Lordosis and Kyphosis.

The two forward curves seen in the neck (cervical spine) and the lower back (lumbar spine) are called normal Lordosis. The two backward curves seen in the chest (thoracic spine) and hip areas (sacrum) is called normal Kyphosis. Though the lumbar region carries most of the body’s weight, each segment depends on the strength of the others to function properly.

Low back pain is a very common complaint for a simple reason: since the lumbar spine is connected to the pelvis, this is where most of your weight bearing and body movement takes place.

It is important that you learn to maintain optimum posture: it will help you maintaining the optimal alignment of the spine of your clients. Remember that our training can influence our posture, and if our posture is misaligned then this can trap us (and our clients) in a cycle of injury and poor performance, be it in the gym, the sports ground, or in day-to-day activities.

Though postural assessments are best done under the watchful eye of a specialist, some of the easy tips that you can use is to learn to stand and walk with your feet and toes parallel to each other and your feet below your hips.

Keep your ‘tail’ tucked in by keeping your pelvis in a neutral position. Women tend to have a greater degree of anterior pelvic tilt; therefore they can keep their pelvis around 10-20 degrees more than the neutral pelvic position.

When viewed from the side the shoulders should be kept pointing out to the side for men, and women can keep it around 10 degrees forward. The ear and the middle of the shoulder should be in line with the chin, parallel to the floor.

The benefits of optimum posture include improved balance, flatter abdominals, ‘true’ height due to optimum alignment and better muscle co-ordination, and total body power and strength output.

Maintaining mobility

From a standing position a healthy spine should allow us to bend forward into flexion 40-60 degrees and extend the spine backwards 20-35 degrees. Side bending (lateral flexion) should be around 15-20 degrees. It is important to note that all these ranges for a healthy spine should be with a stationary pelvis which doesn’t displace in the opposite direction of the bending.

When it comes to rotation of the spine, the lumbar region provides only up to 10 degrees of rotation. Therefore, excessive rotation of the lower back – with exercises such as twisting medicine ball throws or Russian twists with a cable – should be performed without arching the lower back to get increased range of motion.

You will now understand why the old-school bend-forward and twist exercise is actually not that great an idea for the lower back. It becomes even more risky when the movement is done at high speeds. The combination of forward flexion of the lower back, combined with rotation at the hip and speed is a great way to mess your back!

The same holds true for standing rotations with a stick placed across the shoulders. They become worse if seated as the pelvis is then “locked” on to the bench and excessive rotation places greater stress forces on the lumbar vertebrae.

The thoracic spine, in fact, provides a greater range of rotation: approximately 45 degrees. Therefore, it is important to keep it mobile by performing specific exercises such as thoracic spine rotations.

The thoracic spine and the muscles surrounding it can get stiff due to sitting in front of a computer for long in a hunched position, or long-distance driving, or on account of poor strength training habits and general poor posture. Excessive shortening of the pectoral muscles, latissimus dorsi, upper trapezius from short range strengthening exercises such as bench presses, lat pull-downs, pull-ups, can place these muscles and their attachment points in unfavourable positions.

Similarly, weakening and lengthening of the muscles in the back – such as the rhomboids, middle and lower trapezius – can also compound this problem by developing a hunched upper back posture often seen in bodybuilders, or in office workers due to their long hours slouched over work.

A foam roller used on the thoracic spine is a great way to improve and maintain mobility in that region. It is generally not advisable to use the foam roller on the lumbar region, which needs more stability than mobility.

Muscle injury

Remember that your joints allow flexibility, while muscles allow mobility. Though quite a few muscles are attached to the spine the para-spinal muscles that run next to them help support the spine in its movement.
These muscles can be injured directly, such as when you have a pulled muscle or muscle strain of the back muscles. The muscles can also cause problems indirectly, such as when the muscles are in spasm after injury to other parts of the spine.

HOW ARE MEN & WOMEN DIFFERENT?

One of the major differences between the male and female spines in humans is seen in the pelvic bone, which is a large bone on which the spine sort of rests. Females have a larger and broader pelvis – to facilitate childbirth.

Women’s lower spines have evolved to be more flexible and supportive than men’s to increase comfort and mobility during pregnancy, and to accommodate carrying of babies in their arms after birth.

A study by researchers at Harvard and the University of Texas found that pregnant women lean back by as much as 60% by the end of their term. By doing so it helps them maintain a stable centre of gravity above the hips.

In women the loading at the lumbar spine occurs around three vertebrae to take weight more efficiently. In men it happens across only two lumbar vertebrae.

The female joints are also larger and flare out further down the spine than those of males, improving the spine’s strength. All of this contributes to an increased ability to extend the spine during pregnancy for women.

When you experience a muscle spasm, it is because your muscle tightens up and will not relax. These spasms usually occur as a reflex, meaning that you cannot control the contraction of these muscles. When any part of the spine is injured – including a disc, ligaments, bones, or muscles – the muscles automatically go into spasm to reduce the motion around the area. This protective mechanism is designed to protect the injured area.
Most lower back pain will resolve within six weeks after the physiotherapist or doctor has advised any of the various treatment modalities available: bed rest, acupuncture or dry needling, bio-mechanical and postural assessment, medication, heat packs, ultrasound physiotherapy, abdominal brace, taping, machine treatment, etc.

Doctors suggest surgery only as a last resort, after every effort to treat pain conservatively has failed and if the pain is excruciating, making even day-to-day activities very difficult for a long period of time.

MOVEMENTS BEST AVOIDED
  • Yoga plough: Puts the cervical spine in an extremely flexed position, plus his/her bodyweight on top of it.
  • Barbell good mornings: The        position of placing the bar around the shoulder and bending forward from the hip places unnecessary stress on the lumbar region. The weight is placed very far away from the fulcrum, which in this case is the hip. Rounding the lower back in this position with the weight on your client’s back is absolute murder for the lower back.
  • Straight-legged sit-ups and raises: These moves involve the hip flexors, and as the legs touch the floor they cause excessive arching in the lower back.
  • Swinging toe touches: The element of extreme range of motions, where people swing themselves down from an arms overhead position to touch their toes, and back at high speed, is not loved by your lower back.
  • Locking knees: Locking the knees while performing most exercises, including stiff-legged dead lifts, will cause the pelvis to rotate anteriorly and arch the lumbar spine. Ensure that the client gets into the habit of keeping his / her knees bent slightly. If bending forward, he / she should perform the ‘hip-hinge’ action where he / she pushes the hip joint back, as if pushing someone back with his / her butt as he / she bends down.

functional training
The core.

Core of the matter

To understand the spinal system better, it is equally important to understand the “core”, which basically comprises of small and big muscles that contribute to maintaining core stability of a person’s body over a constantly changing base of support.

An example would be when someone performs a squat, where the hips travel over a distance, without the person losing balance and falling over. Another example would be of a badminton player who constantly moves around the

court, shifting his/her bodyweight between two feet to the right and left legs, jumping and lunging, yet managing balance.

A different example would be that of a surfer balancing his/her body over an unstable surface such as a surfing board. All of these movements would require a good amount of core stability in order to improve performance and stay injury-free.

Core stability comprises of the following and would require their integrated neuro-muscular control, ensuring coordinated activation of all systems at the right time and with the right amount of force:

  • Local or inter-segmental stabilization system made up primarily of the transverse abdominus, internal obliques, lumbar multifidus, pelvic floor musculature and diaphragm;
  • Global stabilization system primarily made up of muscles that attach from the pelvis to the spine. These include the quadratus lumborum, psoas major, external oblique, portions of the internal oblique, rectus abdominus, gluteus medius and adductor complex;
  • Global movement system that is made up of muscles that attach the spine and/or pelvis to the extremities like the legs and arms. These include some of the big power producing muscles such as the latissimus dorsi, hamstrings, gluteus maximus and hip flexors.

It is important that we train the core stabilizers of our clients for efficient stabilization of the spine during movements. A weak core will cause loss of power and predispose the lower back to injuries.

One example would be of someone performing a standard deadlift in the gym. If his/her gripping strength and leg drive are well developed, but the core stability is weak, then the amount of weight lifted and the associated gains would also be limited.

Another example would be that of a cricket player throwing a ball, or a boxer throwing a punch. If their core stability is poor, they would lack control as they rotate their bodies to initiate and finish the movement – thus the push-off from the legs wouldn’t be efficiently transferred to the arms and would cause uncontrolled and excessive rotation, causing power to be lost and putting the spinal structures under unnecessary strain.
An activity such as swimming becomes a great case for the importance of core stability. This is so because, unlike most land-based sports, there is nothing for the feet to ‘ground’ the body while using your arms to pull yourself forward.

Therefore, a strong core is imperative for improved swimming as it will ensure better coordination between arm pulling and leg kicking and preventing unnecessary rolling of the body.

My swimming students – among them Asian bronze medallists Sandeep Sejwal and Veerdhaval Khade, and national record holder Maana Patel – have to follow a swim-specific designed core stability programme to keep their core in prime condition. Any weakness will not only affect their timing but also predispose them to injuries in a power sport such as sprint swimming.

For those interested in aesthetics, a well-designed core stability programme will also help to ‘tighten’ your abdominal and waist regions.

Strong spine

Follow these guidelines to make the most out of your back strengthening programme:

  • One of the most important, but often neglected, aspect of strengthening of any part of the body, including the spine, is nutrition. A lack of Calcium and Vitamin D3 has been shown to affect bone density and muscle recovery.

Therefore, following a diet which helps you get stronger is as vital as following an exercise programme to get you stronger. Trying to make your client train hard without proper nutrition is like trying to race a car with insufficient or poor quality fuel in the tank.

  • Reduce excess bodyweight, especially around the waist, because it places extra load on the spine. If your client has 10 kg excess bodyweight, it would be like carrying a 10-kg dumbbell tied to his/her body.
  • Be extra focussed when you prescribe any exercises that involve bending, lifting and twisting (BLT), especially with the client’s excess weight. BLT exercises must also take into account any back injury or recovery.
  • Though long-distance running doesn’t place direct load on the spine, the constant pounding on hard ground can place great amounts of loading and stress and sometimes lead to pain in the cervical spine.

Therefore optimum running technique is necessary, so that the landing impact is absorbed by strong muscles, rather than by components of the skeleton (knee joint and spine). Remember that the shock-absorbing capacity of most running shoes is reduced with use and age. Discourage your clients from using worn-out shoes for running.

  • The glutes play a major role in extension of the upper body from the hip joint. Glutes, lower back and hamstrings work together to extend the body at the hip joints. Therefore, weak glutes can make you shift the load being lifted on to the lower back instead. Strong gluteals are important if your client wants a stronger lower back.
  • Mobility in the hip joint is necessary as tight hip flexors – such as the rectus femoris, psoas major and illiacus – pull your pelvis into an anteriorly tilted position and your lumbar spine into unwanted extension, thus increasing the chances of putting pressure on your discs. Static stretches for your hip flexor can play a vital role in reducing load on the lower back.
  • Discourage your clients from wearing footwear with high heels: because the lumbar spine has to compensate for the altered position of balance, it changes the point at which the centre of gravity is located. Though women are better adapted to wearing high heels, it should be kept to a bare minimum.

WHEN TO REFER TO A DOCTOR?

Though most physiotherapists and trainers will try their best with good intentions to help a client with back pain, it is important for them to know when to stop trying and refer the client to an orthopaedic specialist.

  • Pain caused by an injury
  • Pain so severe the client can’t move around or sleep
  • Pain continues down his/her leg and below the knee
  • Numbness in the leg, foot, groin or rectal area
  • Accompanied by fever, nausea, vomiting, abdominal pain, weakness or sweating
  • Loss of bladder or bowel control
  • History of osteoporosis or cancer
  • Unexplained weight loss
  • History of taking steroid medications or substance abuse.

Gym routines

When performing strength exercises in the gym, choose those movements earlier in your client’s routine that load the spine due to excessive external load or due to forward flexion. Basically, let him/her lift heaviest when he/she is freshest.

Let him/her perform the heavy dead-lifts first (hip approximately 45 degree flexion and maximal load), followed by bent-over-barbell rows (hip 90 degree or less flexion and moderately heavy load), followed by seated cable rows (no bending forward, but weight pulling you forward), followed by lat pull-downs or pull-ups (spine upright and forced applied downwards while pulling), and finally the pullovers (spine resting on the bench).

Ensure that your clients do not excessively arch their lower backs while pushing their butts out with strength training exercises. This position creates an altered length-tension relationship at the lumbo-pelvic-hip complex; it not only puts excessive strain on the lumbar region but will also reduce their strength by reducing stability.

The neck muscles are often neglected in training, but they play a vital role as they provide a stable base of support for the head. Therefore help your clients perform isometric contractions of the neck by placing their palms on the side of the neck and exert pressure on it while keeping the neck long and the scapulae (shoulder blades) stabilized by pulling them down and back.

If performing lower back extensions on a bench to strengthen the lower back, the navel should be positioned on the edge of the bench and bending from the lower back, so that erector spinae (lower back extensors) are worked dynamically. Placing the hip at the edge will cause the low back extensors to get into a “locked” isometric contraction and the major work is done by the glutes.

– Deckline Leitao (CSCS, NASM- PES, CES, CPT)

Gym software The writer completed his B.Sc. (Sports Science) in South Africa and P-G Diploma (Sports) in London. He is one of India’s most qualified and experienced fitness specialists working with high-level sportspersons
(www.decklineleitao.com)

 


 


 

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