spinal isolation, restriction & rehabilitation...exercise. not only can we irritate the spinal...

Spinal isolation, restriction & rehabilitation

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©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

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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

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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.

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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?

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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?

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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

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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.

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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.

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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.

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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.


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



✓ pelvic bridges with small low load ranges where the client may roll through the spine

✓ upright low load spinal twist


✓ Sitting oblique work in neutral spine


Also make sure that the client does not to shorten the one side of the torso as they exercise.

NB:










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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.


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



✓ 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


✓ Gentle spinal press into a 65cm ball sitting

✓ Seated low load abdominal hinge


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 pathology, and however, if

the movement is performed in





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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.


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.


✓ 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:










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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

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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

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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

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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.

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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.


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.


compensation

Sitting lumbar mobility

(flexion)

Pelvic curl (flexion)

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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

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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

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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:


compensations

Thoracic extension on the

foam roller

Thoracic extension with

the discs

Thoracic spine

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Can you design two new exercises for thoracic back extension See our examples below!


compensation

Thoracic extension with

the 65cm ball seated


compensation

Thoracic extension

seated with a 20cm ball

Exercises to encourage segmental extension:


compensations

Sitting extension –

chair / wall

Roll down – sitting

upright

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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

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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)

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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

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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.

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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

https://www.canstockphoto.com/

http://sciaticapainrelieftoday.com/spinal-fusion-for-sciatica-a-more-common-surgical-alternative-for-recurring-sciatica.html

spinal isolation, restriction & rehabilitation...exercise. not only can we irritate the spinal...

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