Spinal isolation, restriction & rehabilitation
2 | P a g e
©Copyright January 2015, Of-CourseOnline – Spinal isolation, restriction & rehabilitation (Tanya Thompson), South Africa
Contents INTRODUCTION AND COURSE BREAKDOWN ............................................................................................................................3
Anatomy.....................................................................................................................................................................................4
• The muscles involved .........................................................................................................................................................5
A quick overview ........................................................................................................................................................................8
What else affects spinal mobility ...............................................................................................................................................8
Precautionary measures for disc pathology ........................................................................................................................... 10
Posterior bulging disc.............................................................................................................................................................. 10
• Anterior bulging disc ....................................................................................................................................................... 11
• Lateral bulging disc ......................................................................................................................................................... 12
• Spinal Fusions ................................................................................................................................................................. 13
• Spondylolisthesis ............................................................................................................................................................ 14
Spinal mobility and breathing ................................................................................................................................................. 14
Spinal isolation and movement .............................................................................................................................................. 16
Testing: Spinal mobility and isolation in cervical, thoracic and lumbar spine ....................................................................... 17
• Cueing: ............................................................................................................................................................................ 20
Common cheats during training of the back extensors .......................................................................................................... 20
Thoracic spine ......................................................................................................................................................................... 21
• Exercises to achieve thoracic extension: ....................................................................................................................... 21
• Exercises to encourage segmental extension: ................................................................................................................ 22
The importance of spinal isolation ......................................................................................................................................... 23
Lumbar mobilization and strength ......................................................................................................................................... 23
• Example of a posture requiring lumbar isolation: .......................................................................................................... 23
The deep neck flexors ............................................................................................................................................................. 25
• Exercises to re-educate deep neck flexion: .................................................................................................................... 26
3 | P a g e
©Copyright January 2015, Of-CourseOnline – Spinal isolation, restriction & rehabilitation (Tanya Thompson), South Africa
INTRODUCTION AND COURSE BREAKDOWN
Outline of course: Spinal isolation, restriction and rehabilitation
Effective movement of the spine is achieved if the professional teaching the movement has an understanding and mind body connection of how the
spine feels and looks when performing pure and safe movement. Mindful training of the spine encourages a healthy spine and promotes longevity. In
this course we look at all the aspects that are important when training the spine i.e. spinal isolation for postural improvement, precautionary
measures when dealing with certain spinal pathology, spinal retraining and the muscles involved, the practical exercises that work in order to retrain
the spine and the role that the spine, hip and pelvis play on each other.
Objectives: This course is to develop insight into the movement of the pelvic, hip and spine in order to add to the process of pelvic, hip and
spinal rehabilitation. We take a deeper look into pure and safe movement as well as functional training of the spine with the objective being
client specific training.
Course description:
➢ Quick recap on anatomy that is involved in the spine, hip and pelvis
➢ Understanding spinal restrictions and the causes of these
➢ Understanding how certain movements are contra-indicated to certain injuries or pathology
➢ Mindful training and precautionary measures for the spine and spinal pathology
➢ Spinal isolation and segmental training
➢ The importance of the thoracic extensors and deep neck flexors and how to train these efficiently
Course requirements:
➢ Computer, Internet, Manual (to be printed off of website), stationery
Course agenda:
1. This course is done online at a time convenient for the candidate
2. The course is presented via a video so the candidate is able to watch the course and follow the presenter from the manual
3. The course is divided into sessions and therefore they can do one session at a time
4. The course duration is approximately 3.5 hours
5. At the end of the final session, they are to complete a test at their convenience
6. They will also receive the 1-page course summary
7. A certificate will be available once they have achieved 70% on the test
4 | P a g e
©Copyright January 2015, Of-CourseOnline – Spinal isolation, restriction & rehabilitation (Tanya Thompson), South Africa
When looking at the anatomy of the spine, remember that a muscle works and controls both eccentrically and works under high
or low load concentrically. Therefore, a muscle could be weaker concentrically but stronger eccentrically depending on the
activities and load that you expect it to endure on a daily basis. However, this does not mean that the muscle is strong, it just
means that there is more effort exerted from the muscle in an eccentric or concentric position on a daily basis.
There are many factors that influence the mobility and range of the spine i.e. hereditary restrictions
or merely due to negative spinal mechanics and everyday activities. The spine forms a bridge between
our extremities and has a superior bond with the pelvis. Therefore, it is extremely important to know
when enough is enough?
First and foremost, it is important to understand the anatomy of the spine including the muscular system. There are
many factors that come into play when mobilizing or strengthening the spine and these need to be considered to avoid
permanent injury.
Anatomy
Eccentric control:
Controlling a joint as the
muscle lengthens
against low resistance.
Eccentric work:
Controlling a joint as the
muscle lengthens
against high resistance.
Concentric contraction:
Shortening of the muscle against high or
low load which will decrease the joint
angle
What is muscle strength?
A group of muscles may have a great ability to contract but the amount of load and
repetitions that the group can handle will indicate the amount of strength that the group
has. Therefore, in order to obtain strength, we need to add resistance and additional
repetitions.
Hence, through postural assessment we cannot conclude that muscles are strong or weak
until we physically test them.
5 | P a g e
©Copyright January 2015, Of-CourseOnline – Spinal isolation, restriction & rehabilitation (Tanya Thompson), South Africa
The muscles involved
Erector Spinae
Spinalis (Concentrically)
Attachments: spinous to spinous process (interspinalis); Transverse (T5/6 ) to Spinous
process (C2-C5)
Movements: spinal stability segmental spinal extension; bilateral spinal extension;
spinal rotation toward opposite side; localized spinal lateral flexion to that side
(cervical area & intertransversarii)
Longissimus:(Concentrically)
Attachment: originate and insert at various points along the transverse processes of
the entire spine
Movement/s: bilateral spinal extension; lateral spinal flexion to same side
Iliocostalis: (Concentrically)
Attachments: along the sacrum, lumbar spinous proceses, sacrospinalis
aponeurosis and illium to the ribs above and transverse process of cervical
vertebrae
Movements: extension in thoracic & lower cervical regions; stabilizes,
extends and laterally flexes thoracic spine to same side as it assists by
depressing the ribs
Notes:
These are our main global spinal extensors that also control flexion of the spine in a standing position when you do
a roll down. It is important to note that the attachments of the spinalis is noticeably different compared to the
longissimus and iliocostalis. Therefore, the spinalis is capable of performing segmental extension. Due to this
function, it plays a vital role in spinal isolation where we would need to isolate areas of the spine in order to
improve postures.
What would the antagonists be to the erector spinae?
6 | P a g e
©Copyright January 2015, Of-CourseOnline – Spinal isolation, restriction & rehabilitation (Tanya Thompson), South Africa
Quadratus Lumborum
Attachments: Illiac crest, transverse processes of lumbar vertebrae, last rib (12th
rib)
Movements: Aids in depressing the ribs during breathing Holds the 12th rib
down as we inhale and as we exhale the ribs come down it will move into a
slightly shorter position; unilaterally flexes the spine to the same side; elevates
the hip unilaterally; extends the lumbar spine; pulls the pelvis into an anterior tilt;
rotation of the spine to the same side.
What would the QL’s antagonists be?
Multifidus
Multifidus: (Concentrically)
Attachments: the feathered muscle in lumbar, thoracic and cervical
regions. Spanning 2 – 4 vertebrae runs from sacrum and transverse
processes to the 2nd or 4th superior spinous process above it and continues
to C2
Movements: the main function is spinal stabilization; however, some literature
has mentioned that the multifidus would assist with spinal extension and rotation
toward the opposite direction
What would the Multifidus’s antagonists be?
7 | P a g e
©Copyright January 2015, Of-CourseOnline – Spinal isolation, restriction & rehabilitation (Tanya Thompson), South Africa
Attempt to visualise the layers of muscles surrounding the spine…
Superficial layers include the Erector Spinae group (except Spinalis) and Splenius (cervical) group. Oblique layers consist of the Scalenes
(anterior, medius,posterior). Deeper layers involve Longis Capitis and Longis Colli (central/ anterior deep neck flexors). The deeper back
extensors include the Quadratus Lumborum and deeper Spinalis groups (first layer), Multifidus (second layer) and the Rotatores being the
deepest (third layer). Interspinalis and intertransvesarii are right along the spine.
Rotatores
Rotatores: (Concentrically)
Attachments: transverse process of vertebra and base of spinous
process of vertebra above it
Movements: spinal extension, rotation and lateral flexion on a
smaller scale. Due to their size, the rotators are less likely to work
intensely in these movements and will therefore be synergists to the
movements mentioned. They also assist in stabilizing the pelvis but
have a strong sensory component where they play a role in
proprioreception of the vertebrae as they move.
What would the Rotatores antagonists be?
Scalenes Longus Colli Longus capitis
8 | P a g e
©Copyright January 2015, Of-CourseOnline – Spinal isolation, restriction & rehabilitation (Tanya Thompson), South Africa
Muscle Movement
Concentrically
Antagonists Moves Lumbar spine
into flexion/extension?
Abdominals Spinal flexion and rotation Back extensors, hip flexors Flexion
Hip Flexors Hip flexion Abdominals, hip extensors Extension
Gluteus Maximus Hip extension, abduction and
lateral rotation
Hip flexors, back extensors Flexion if you posteriorly
tilt the pelvis but
extension if you
hyperextend the hip
Hamstrings Hip extension, knee flexion
and slight knee rotation
Hip flexors, back extensors Flexion if you go into a
posterior pelvic tilt but
extension of the spine if
you raise the leg beyond
20° behind you
Anterior Posterior
A quick overview
What else affects spinal mobility
Spinal cord: this runs through the vertebral
foramen and can therefore be affected through
movement of the spine. This should always be
taken into consideration, especially if a client feels
a neural pull, tingling or a sharp pain during any
exercise. Not only can we irritate the spinal cord
or nerves through movements but the irritation is
exasperated if it is performed with an existing
spinal pathology where the spinal cord is
compressed.
Posterior and anterior longitudinal ligaments: these are the ligaments
of the bodies of vertebra and protect the spine from flexing or
extending too far. Due to the fact that these are ligaments, they are
restricted in their flexibility and therefore the spine should not be
forced to enable a client to get more flexibility if the restriction lies
within these ligaments. In this case you will normally find that it is
hereditary. Forcing large ranges of mobility can cause direct
complications with the intervertebral discs. If the client is not required
to do large ranges of motion in their spine in their everyday lives then
this is better left as is. Many instructors do not consider the influence
that the ligaments of the spine have on mobility and always ‘assess’ it
down to the muscles of the back being tight. Remember, joints can be
affected by muscles, ligaments and their general structure.
9 | P a g e
©Copyright January 2015, Of-CourseOnline – Spinal isolation, restriction & rehabilitation (Tanya Thompson), South Africa
A quick look at a vertebra’s structure
Intervertebral discs and fusions: It is very important to be aware of these conditions as certain conditions have
movements that are contraindicated to them. Therefore, if they are put into the contraindicated position, the condition
could worsen. Remember that as the spinal cord is running through the vertebrae, it could be affected by the vertebrae’s
movement or changes. Nerve roots radiate out of each vertebra which may also be affected through the movement of
the spine especially when a disc issue is present.
NB:
MOVEMENT OF THE SPINE IN MEDIUM TO LARGE RANGES IS AVOIDED WITH DISC PROBLEMS.
DO NOT:
• Load the spine in extreme ranges
• Create traction in the spine e.g. prone hanging over a ball
• Excessively flex or extend the spine
• Combine flexion or extension WITH rotation
Ranges should be kept to no more than 20% of the NORMAL range initially to ensure safety during exercise
ALWAYS:
• Ask for a thorough report from the health care professional which states; diagnosis, their suggestions of program and contraindications.
• Ask client for constant feedback and follow up with them the next day to see how they felt after the session.
• Keep a record of each and every program that you offer them.
10 | P a g e
©Copyright January 2015, Of-CourseOnline – Spinal isolation, restriction & rehabilitation (Tanya Thompson), South Africa
Posterior bulging disc:
The disc will be bulging towards the spinal cord and this could cause neural pain in
various areas depending on the disc that is bulging and the individual who is experiencing the pathology.
Therefore, Flexion of the spine is avoided as it will protrude more towards the spinal cord
creating various symptoms. Flexion and extension with rotation is also avoided.
4 movements that you would avoid with this condition:
1. A standing roll down where the spine experiences traction due to the weight of the torso and gravity
2. Crunches or chest lifts where you round the part of the spine where the disc is bulging
3. Any spinal articulation in flexion i.e. pelvic curl, tower, long spine, short spine
4. Any heavily loaded exercises for the spine e.g. deep squats with HEAVY weights
Remember that the response of muscles changes depending on whether you are sitting, standing or prone.
If you are unsure of an exercise, please take a photo and send it to us and we will assist you as far as possible.
It must never hurt!
SUGGESTED PROGRAM
• We suggest lower load exercises on the spine where the spine is held in neutral i.e.
✓ spinal hinges sitting
✓ pelvic bridges without rolling through the spine initially
✓ sitting upright low load spinal twist
✓ Neutral spine against the wall with theraband (closed chain)
✓ Abdominal hinge with theraband resistance
✓ Controlled squat with medium resistance
✓ Basic back extension prone on a long bench
Ensure that you maintain neutral pelvis to ensure that they do not posteriorly tilt their pelvis as this will aggravate the
disc condition.
Precautionary measures for disc pathology
NB:
The spine has 24 vertebrae,
therefore these movements
are avoided only in the areas of
the pathology, however, if the
movement is performed in
another area but the area of
the pathology is affected then
please refrain from the
movement all together.
11 | P a g e
©Copyright January 2015, Of-CourseOnline – Spinal isolation, restriction & rehabilitation (Tanya Thompson), South Africa
Anterior bulging disc
The disc will be bulging towards the abdominal area and therefore extension of the spine is
avoided to ensure that it does not increase the bulge. Also avoid extension and flexion with
rotation.
4 movements that you would avoid with this condition:
1. Any exercise lying prone especially if they cannot maintain a neutral pelvis prone
2. Any hip extension prone as this will increase the extension in the spine
3. Any hip extension standing or sitting where the spine goes into extension
4. Standing roll downs as mentioned in the posterior bulging disc
SUGGESTED PROGRAM
• We suggest lower load exercises on the spine where the spine is held in neutral i.e.
✓ spinal hinges sitting
✓ pelvic bridges with small low load ranges where the client may roll through the spine
✓ upright low load spinal twist
✓ Neutral spine against the wall with theraband (closed chain)
✓ Sitting oblique work in neutral spine
✓ Controlled squat with medium resistance
Also make sure that the client does not to shorten the one side of the torso as they exercise.
NB:
The spine has 24 vertebrae,
therefore these movements
are avoided only in the areas of
the pathology, however, if the
movement is performed in
another area but the area of
the pathology is affected then
please refrain from the
movement all together.
12 | P a g e
©Copyright January 2015, Of-CourseOnline – Spinal isolation, restriction & rehabilitation (Tanya Thompson), South Africa
Lateral bulging disc The disc would be bulging towards the left- or right-hand side. This is commonly seen
together with a posterior or anterior bulge. Lateral flexion of the spine away from the
bulge is avoided as this will cause the disc to bulge further laterally. Extension and flexion
with rotation is also avoided initially. If the disc is bulging anteriorly or posteriorly
then you will follow the precautionary measures as seen above.
4 movements that you would avoid with this condition:
1. Sides / oblique work where you flex the spine against low or high load
2. Spinal rotation until you get the ‘go ahead’ from the health care professional
3. Side plank as the spine is vulnerable in lateral work especially under load
4. Side or oblique stretches where the spine is in lateral flexion
SUGGESTED PROGRAM
• We suggest lower load exercises on the spine where the spine is held in neutral i.e.
✓ spinal hinges sitting
✓ pelvic bridges with small low load ranges where the client rolls through the spine or hinges, depending if the lateral
bulge is just lateral or lateral anterior or lateral posterior
✓ upright low load spinal twist
✓ Neutral spine against the wall with theraband (closed chain)
✓ Gentle spinal press into a 65cm ball sitting
✓ Seated low load abdominal hinge
✓ Controlled squat with medium resistance
Ensure that you maintain neutral pelvis to ensure that they do not anteriorly or posteriorly tilt their pelvis as this could
aggravate the disc condition.
NB:
The spine has 24 vertebrae,
therefore these movements
are avoided only in the areas of
the pathology, and however, if
the movement is performed in
another area but the area of
the pathology is affected then
please refrain from the
movement all together.
13 | P a g e
©Copyright January 2015, Of-CourseOnline – Spinal isolation, restriction & rehabilitation (Tanya Thompson), South Africa
Spinal Fusions
The vertebrae are fixed to one another through surgery or they join naturally (ankylosing spondylitis) and therefore offer no
mobility in the area of the fusion. Excessive mobilization is avoided due to the restricted mobility in the area of the fusion.
Therefore, the vertebrae above and below the fusion are placed under stress in excessive spinal mobilization due to the fact that
they have to take more load and mobility during a movement.
4 movements that you would avoid with this condition:
1. Deep spinal flexion loaded
2. Deep spinal extension loaded
3. Excessive spinal rotation loaded
4. Any rolling on a mat especially when the spine ‘thuds’ on the mat due to the area of the fusion that appears flat
SUGGESTED PROGRAM
• We suggest lower load exercises on the spine but you are able to perform flexion, extension and rotation of the spine in a small
range (20% of the original range) i.e.
✓ spinal hinges sitting
✓ pelvic bridges with small low load ranges where the client rolls through the spine
✓ pelvic curl (do not expect articulation in the area of the fusion)
✓ Chest lift or abdominal work (do not flex neck under load if the fusion in near C7 or
overload the spine at the area of the fusion)
✓ upright low load spinal twist,
✓ neutral spine against the wall with theraband (closed chain)
✓ gentle spinal press into a 65cm ball sitting
✓ seated low load abdominal hinge
✓ controlled squat with medium resistance
✓ spinal extension i.e. basic back extension, swimming
Ensure that you maintain a comfortable pelvis as they often appear to be posteriorly tilted when they have had a
lumbar fusion. If this is the case then maintain a comfortable, small lumbar flexion (posterior tilt). If you force the
spine into neutral and it is fused in slight flexion, you will strain the vertebra above and below the fusion.
NB:
The spine has 24 vertebrae,
therefore these movements
are avoided only in the areas of
the pathology, however, if the
movement is performed in
another area but the area of
the pathology is affected then
please refrain from the
movement all together.
14 | P a g e
©Copyright January 2015, Of-CourseOnline – Spinal isolation, restriction & rehabilitation (Tanya Thompson), South Africa
Spondylolisthesis
Conditions such as Spondylolisthesis would be treated similarly to an anterior bulging disc as there is discomfort when
extension is done. Spondiloysthesis is where there is a shift in the vertebral body which could be due to a fracture in the
vertebra. Due to this there is an instability and the vertebra has the ability to shift. The shift is usually anteriorly and
therefore extension is avoided as this would exacerbate the condition.
Please refer to precautionary measure for anterior and posterior discs!
Breathing plays a vital role in spinal isolation and mobility. A certain amount of tension is created in the torso
(especially on exhalation) when we breathe and therefore releasing in the vertebrae becomes more challenging.
The mobility and free movement of the spine is also affected when we have an insufficient breathing pattern. It restricts
the mobility of the thoracic spine and due to this we are not able to maintain a reasonable thoracic spine position. The
outcome is that thoracic spinal extension is limited. (It is important to spend additional time when teaching your client
breathing.)
Vertebral shift
Spinal mobility and breathing
15 | P a g e
©Copyright January 2015, Of-CourseOnline – Spinal isolation, restriction & rehabilitation (Tanya Thompson), South Africa
It is always important to do a client assessment because this give you a strong base to work from and a better understanding of
the clients body and needs. It is also far easier to keep track of improvements as the program progress. Remember that if there
is a restriction in the spine, the muscles that were discussed earlier will also be affected. (Refer to page 4 – 6)
WHEN IS ENOUGH, ENOUGH?
We are often not sure what causes the restriction in the back. Often the client has not consulted a health
care professional as there are no symptoms, only stiffness.
We can narrow it down to it either being due to bad habits or hereditary.
(This is easier to see if you have another family member training at your facility.)
The 3 factors that affect the spinal mobility are:
1. Muscles: this can usually be improved through constant stretching and mobilization of joints. However,
you need to realize that it could take a long period to see considerable improvement.
• Efficient stretching is vital.
• Ask if they are feeling a muscular stretch.
• Keep the joints in good alignment
• Be aware of a neural sensation when they stretch as this may not be held for longer than 3 – 5 seconds
2. Ligaments: the improvement here will be minimal, however, remember that if the ligaments are stiff
then that would directly affect the amount of movement and flexibility that occurs in the muscles of the
back. Therefore, the muscles can improve but they will reach a limit due to the ligamentous properties.
Any forced stretching of the spine can cause other pathology if the spine is restricted through its
ligaments.
3. Fascia: this is usually released through manual massage and should be done by a health care
professional who understands the positioning and composition of the fascia.
Which muscles will be inhibited if the spine is
restricted from achieving flexion? Abdominals
Which muscles will be inhibited if the spine is restricted
from achieving Extension? Back extensors
Which muscles will be inhibited if the spine is restricted
from achieving Rotation? Obliques & spinal rotators A quick reminder
16 | P a g e
©Copyright January 2015, Of-CourseOnline – Spinal isolation, restriction & rehabilitation (Tanya Thompson), South Africa
Rotation: (Remember that the spine is able to do 30’ of rotation)
We should never underestimate the importance of spinal rotation as we have specific
muscles that are responsible for this movement. They are:
• Obliques, rotatores, serratus posterior inferior, quadratus lumborum &
assisting spinal rotators
Many clients tend to rotate from the feet, knees and hips in order to facilitate spinal rotation and this is only necessary
once the spine has reached it maximum range of motion in rotation (30°). However, if they do not have mobility in the
muscles mentioned above then the compensation would be to rotate from the hip, knees and feet. This also does not
allow for the development of the rotating muscles. Due to this, it is common that the spine gets injured when loaded
rotation is performed as the spine is not accustomed to this movement.
What movements do we want to enable the spine to do?
We know that the vertebrae are able to articulate or they should be. This however is not the case in many clients. When
looking at spinal isolation or segmental extension and flexion, we are directly referring to the spinalis and the smaller spinal
extensors. The positioning of these muscles enables the spine to do segmental extension and control flexion segmentally. It
is usually easier to teach this to a client that is less active as the larger Erector Spinae are usually predominant in an active
individual i.e. sportsmen/women.
We want the spine to:
1. Flex and extend in the cervical, thoracic and lumbar spine.
2. Rotate from left to right with a stable and fixed section i.e. pelvis stable or upper torso stable. Rotation occurs mainly
at the lower thoracic vertebrae.
3. Isolate areas of the spine; here we want the spine to flex or extend the thoracic with minimal change in the lumbar
spine and visa-versa. This is a movement that requires a lot of thought from the client and once this is achieved, one
can look at postural corrective work. For example: A kyphotic lordotic posture where the lumbar spine needs to flex
slightly and the thoracic spine needs to extend more.
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
NB: The majority of clients have very little isolated mobility in the spine, however due to the
fact that they have never experienced true mobility, they are not aware of the restriction that
it creates in their spine and the release of tension that can occur when the spine is able to
mobilize in all positions.
It is up to the instructor to assess the various areas of the spine to get a good idea of what is
required and how well the client understands the concept of spinal isolation.
Spinal isolation and movement
17 | P a g e
©Copyright January 2015, Of-CourseOnline – Spinal isolation, restriction & rehabilitation (Tanya Thompson), South Africa
Below are a few tests that one can do. Please note that if you are already familiar with the tests below, then you need to ensure that
you are able to see the compensations and correct these or note what is causing the compensation.
Testing: Spinal mobility and isolation in cervical, thoracic and lumbar spine
Cervical spine: The cervical spine tends to be very controlled in its movement with very little free movement
occurring in the neck. Movement should be free and easy. The lack of this is due to neck & shoulder tension. This is really
a mind-body connection challenge that needs to be addressed. Free movement will also relieve tension in the neck which
is vital for healthy living. Care should be taken that the client has no neck conditions which would be affected by any of
these movements i.e spinal fusions, disc issues or whip lash.
Exercise Images Common
compensations
Neck rotations and
lateral bending
Neck rolls – free
movement
NB: The movement should not look robotic or cause
unnecessary pains or aches.
18 | P a g e
©Copyright January 2015, Of-CourseOnline – Spinal isolation, restriction & rehabilitation (Tanya Thompson), South Africa
CIMR = This concept can create substantial
body resistance in an exercise whereby
muscles create resistance within the body
for primary movers.
Thoracic spine: It is very important to focus on the closing of the ribs
when assessing and teaching thoracic extension. Flaring ribs will encourage
lumbar extension. Rib closure also creates conscious initiated muscular
resistance (CIMR) (Thompson: 2014). There should also be a feeling of
contracting at the area near the mid and lower Trapezius. Bear in mind that the erector spinae are responsible for the
thoracic extension. There should be a feeling of extending up and over a pole and pulling down with the back extensors just
between and below the shoulder blades.
Exercise Images Common
compensations
Basic thoracic extension
sitting
Basic back extension
prone
Lumbar spine: The mobility of the lumbar spine is client specific. Pelvic tilt will also play a role in the constant
position of the lumbar spine. Therefore, it will also affect the true mobility of the lumbar spine. Emphasis needs to be
placed on the rectus abdominus to produce the movement of lumbar flexion or the lumbar back extensors to produce
spinal extension. As this movement is produced, there should still be a feeling of extension through the top of the
head to avoid sinking or collapsing in the spine.
Exercise Images Common
compensation
Sitting lumbar mobility
(flexion)
Pelvic curl (flexion)
19 | P a g e
©Copyright January 2015, Of-CourseOnline – Spinal isolation, restriction & rehabilitation (Tanya Thompson), South Africa
Spinal rotation: Spinal rotation is imperative for functional movement. There are numerous areas that can
restrict spinal rotation e.g. stiffness in the obliques, restriction in the pectorals (if you want them to rotate with abducted
arms) and general stiffness in the spine. Alignment plays a vital role here as it is very easy to cheat rotation through
extending the spine or flexing in the hip and lumbar spine. Also note that rotation occurs mainly from the lower thoracic
spine.
Exercise Description Common
compensations
Side lying rotation
Cross legged rotation
Entire spine: This is so important to test as it will give you a good idea of whether the client is capable of segmental extension
and flexion as well as the tension that they carry in their spine on a daily basis.
Can you think of a low load exercise that would encourage lumbar flexion? (Supine on a 65cm ball / Anterior theraband
sitting on a 65cm ball)
______________________________________________________________________________________
Why is it important that we emphasize the exercise to be of a lower load? If we add high resistance from the beginning,
the muscles might spasm as they are not used to high load work.
What information can we get from a pelvic curl when it comes to spinal mobility?
1. The range of lumbar flexion
2. The range of lower thoracic extension
3. The ability to perform spinal isolation
20 | P a g e
©Copyright January 2015, Of-CourseOnline – Spinal isolation, restriction & rehabilitation (Tanya Thompson), South Africa
Cueing: Cues that are beneficial to use when teaching spinal isolation are:
• Extend up and over when doing thoracic extension
• Draw the back extensors towards the hips as you do thoracic extension
• Open the chest as you extend the thoracic spine & push your chest through your shoulders
• Draw the rectus abdominus through to flex the lumbar spine
• Feel the activation underneath the shoulder blades in thoracic extension
• Release into the rotation of the spine
• Heavy movement of the neck when performing neck rolls but without force
Be hands on with your clients; apply pressure when needed as the client is are able to recruit the muscles more efficiently when they are aware of where it should be working.
Use of the arms inhibits the back extensors from working efficiently
The clients either lift their arms giving the illusion of height in the back or they press their arms into the floor.
This can be seen by activation in the anterior deltoid as they lift their back up off of the floor.
Overuse of the neck extensors gives the illusion of height in extension
The clients lift their head off the floor with very little change in the back thus giving them an illusion of lifting high in
their backs.
Use predominantly the lumbar spine during back work inhibiting the thoracic spine
This is normally evident when a client lifts quite high off of the surface. They tend to press off of their abdomen with
little change in the thoracic spine and a deep arch in the lumbar spine or they press their legs into the floor causing the
lumbar spine to arch as they go into a posterior tilt in the pelvis.
Changing the pelvic position to encourage back extension
It is common for the client to unknowingly go into an anterior pelvic tilt which will encourage lumbar back
extension.
Common negative movements during training of the back extensors
21 | P a g e
©Copyright January 2015, Of-CourseOnline – Spinal isolation, restriction & rehabilitation (Tanya Thompson), South Africa
How do we get our clients to isolate into their thoracic spine?
The true feeling of thoracic extension is seldom felt by our clients. It is almost better to ask the client to go into a slight
posterior tilt whilst trying to perform thoracic back extension (This will aid them in maintaining neutral). In this way the
lumbar spine will be inhibited from extending and dominating the movement. It is a common occurrence that the
thoracic spine is inhibited in extension and the lumbar spine gives the illusion of back extension along the length of the
spine. The importance of thoracic extension is directly related to posture improvement as our everyday lives tend to
exaggerate thoracic flexion. The initial feeling of TRUE thoracic extension is that of restriction or an intense muscle
contraction. There should be a feeling of maintaining the position of the lumbar spine and only moving the thoracic
spine.
Exercises to achieve thoracic extension:
Exercise Description Common
compensations
Thoracic extension on the
foam roller
Thoracic extension with
the discs
Thoracic spine
22 | P a g e
©Copyright January 2015, Of-CourseOnline – Spinal isolation, restriction & rehabilitation (Tanya Thompson), South Africa
Can you design two new exercises for thoracic back extension See our examples below!
Exercise Description Common
compensation
Thoracic extension with
the 65cm ball seated
Exercise Description Common
compensation
Thoracic extension
seated with a 20cm ball
Exercises to encourage segmental extension:
Exercise Description Common
compensations
Sitting extension –
chair / wall
Roll down – sitting
upright
23 | P a g e
©Copyright January 2015, Of-CourseOnline – Spinal isolation, restriction & rehabilitation (Tanya Thompson), South Africa
Why is spinal isolation important?
• It creates body awareness
• It relieves tension
• It enables the spine to be more functional without compensating
• It also allows all areas of the spine to strengthen effectively which will then encourage good posture and breathing
• It is injury preventative as other areas of the spine do not need to over work due to another area’s weakness
CIMR (Thompson: 2014) = CIMR can create substantial
body resistance in an exercise whereby muscles create
resistance within the body for primary movers.
The lumbar spine is directly affected by the position of the pelvis due to its connection to the sacroiliac joint. Therefore, it
can create various muscular imbalances around the spine. These imbalances will then radiate to the knees, ankles and
shoulders over time.
Mobilization of the lumbar spine is very important as it directly affects isolation of the lumbar back extensors as well as the
Rectus Abdominus.
What is the importance of the co-ordination of these two muscle groups in relation to each other
Co-ordination of these two areas is vital in order to achieve involuntary hip disassociation.
Isolation of the lumbar spine allows us to correct certain postures without any negative repercussion occurring along the rest of
the spine.
Example of a posture requiring lumbar isolation:
Posture Thoracic
spine
Changed position &
muscles involved?
Lumbar
spine
Changed position &
muscles involved?
Kyphotic / Lordotic
Flexion Neutral to extension
Thoracic spinal extensors,
flexibility of upper rectus
abdominus
Extension Neutral
Lower abdominals & hip
extensors
The importance of spinal isolation
Lumbar mobilization and strength
24 | P a g e
©Copyright January 2015, Of-CourseOnline – Spinal isolation, restriction & rehabilitation (Tanya Thompson), South Africa
We have to imagine the body as a pulley system, where antagonists create resistance for the agonists. This term is known as
Conscious Initiated Muscular Resistance (CIMR) (Thompson: 2014). As an isotonic movement is being executed, the body can
create this resistance by the antagonist maintaining a certain amount of tone to avoid another joint from being affected in
the movement. However, the intensity of this can be consciously initiated in order to increase the intensity in the mover.
To assist in correcting postures we need to change the common movement of the lumbar spine and the common movement of the
thoracic spine. These movements could be in opposite directions to one another.
As we know, isolation is a mind – body connection. Therefore, this needs to be established before the true feeling of isolation
can be felt.
Exercises that incorporate all the corrective elements of the following tilts: (Remember: importance of flexibility for ROM
Focal point Exercise Compensations
Posterior tilt
(supine on the 65cm ball) /
Prone over the ball / seated
hip flexion with a hinge)
Anterior tilt
(Prone on the 65cm ball /
supine pelvic ball press)
Lateral tilt (left hip
higher)
(Standing hip hike)
25 | P a g e
©Copyright January 2015, Of-CourseOnline – Spinal isolation, restriction & rehabilitation (Tanya Thompson), South Africa
Normal range of motion of the cervical spine is:
• Flexion – 50°
• Lifting Extension – 60°
• Lateral flexion – 45°
• Rotation – 70° - 80°
What are the deep neck flexors
When we speak of the deep neck flexors, we refer to the Longus Capitis and Longus Colli. These muscles, together with
muscles that are situated posteriorly on the neck, form a sleeve of support for the cervical spine. These can be described
as the core muscles for the cervical spine. Hence, if an injury takes place in the cervical region or if you have a negative
postural position, these muscles become inhibited.
The functions of these muscles are flexion, lateral flexion (not the Longus Capitis) and rotation of the cervical spine.
Therefore, it is important to remember that when exercising the neck, care should be taken as to how much pressure is
applied to the neck as well as the range of movement that you expect from your client.
The deep neck flexors
Longus Colli Longus capitis
26 | P a g e
©Copyright January 2015, Of-CourseOnline – Spinal isolation, restriction & rehabilitation (Tanya Thompson), South Africa
Exercises to re-educate deep neck flexion:
Exercise Image Compensation
Supine with triangular cushion
Theraband neck retraction
Remember that when it comes to the spine, rather safe than sorry should be the order of the day. If you are not sure, do not
attempt to correct. Rather consult other practitioners for advice or guidance and do additional research.
You will only gain from the efforts.
27 | P a g e
©Copyright January 2015, Of-CourseOnline – Spinal isolation, restriction & rehabilitation (Tanya Thompson), South Africa
References
1. Thompson, T. (2019). Training your eye(1st ed., Vol. 1). Pretoria, Non US: Of-CourseOnline.
Assessing the 5 basic movement principles
2. Thompson, T. (2019). Safe Cervical Training. Pretoria, Non US: Of-CourseOnline. A program focusing on safe training for the neck
3. V. (n.d.). Visible Body. Retrieved March 21, 2019, from https://www.visiblebody.com/anatomy-and-physiology-apps/muscle-anatomy Comprehensive Musculo-skeletal system application
4. Strimpakos, J. (2011). The assessment of the cervical spine. The Assessment of the Cervical Spine,115-120. Retrieved July 16, 2016, from https://www.bodyworkmovementtherapies.com/article/S1360-8592(09)00078-3/pdf. Range of motion in the cervical spine
5. Sleeper, M. (Director). (2014, April 17). Goniometric Measurement: Lumbar Extension Range of Motion Measurement[Video file]. Retrieved June 12, 22016, from https://www.youtube.com/watch?v=J1Js0-1Vr6I Lumbar range
6. Thompson, T. (Director). (2019, January 6). Ball obliques[Video file]. Retrieved January 6, 2019, from https://www.youtube.com/watch?v=pkWekxpLcHk Effect oblique work without Quadratus Lumborum compensation
7. C. (n.d.). CanStockPhoto. Retrieved November 12, 2017, from https://www.canstockphoto.com/ Clear anatomy images
8. S., & M. (2013, June 17). Spinal Fusion for Sciatica – A More Common Surgical Alternative For Recurring Sciatica. Retrieved May 5, 2015, from http://sciaticapainrelieftoday.com/spinal-fusion-for-sciatica-a-more-common-surgical-alternative-for-recurring-sciatica.html Insight into a Spinal Fusion
9. Thompson, T. (2018). Kinetic Precision. Kinetic Precision Research Study. Retrieved from https://healthytruthsblog.wordpress.com/2018/10/17/kinetic-precision-study/. The art of Kinetic Precision for effective training
10. B. (2018, April 25). What is spinal pathology. Retrieved September 24, 2018, from https://backpaincenters.com/blog/spinal-pathology An overview of spinal pathology
11. Thompson, T. (2018). Hip stability wow factor. Pretoria, Non US: Of-CourseOnline. A complete guide to healthy hips for longevity