Written by Elyse

By Elyse McNergney, MA, M.Ed, Founder of IMX

Muscles and Movement

The musculature of your back is a very complex network that layers and weaves short muscles,  long muscles, and varying lengths in between.  They intertwine and overlap, connecting to the ribs, pelvis, shoulder girdle, skull and the various processes on the vertebrae.  There are tiny muscles that connect one vertebrae to the next, and others that span several vertebrae. 

The muscles of the spine are grouped according to function and location, and go by names such as the spelenius muscles (move the head), erector spinae (extend the spine), transversospinalis muscles (extend and rotate the spine), segmental muscles (extend and bend the spine to the side), and the scalene muscles (move the neck).  The erector spinae, or spinal extensors, are often associated with lower back pain and spasms. 

Layered over these muscles are some that may be more familiar, namely the trapezius, rhomboids, and a lesser known one called the levator scapulae.  These large back muscles move the shoulder girdle, which consists of your collarbones (clavicles) and shoulder blades (scapulae) and sits on top of your ribcage, basically connecting your arms to your torso.  You probably recognize these bones, because they are fairly superficial or toward the outside of your body, and its easy to see them and feel them move on most people. 

How does this relate to your spine, you ask?  Well, your shoulder girdle is sort of just balanced on top of your ribcage, and the only thing holding it in place is the musculature.  Poor posture and weak muscles allow the shoulder girdle to slide forward, taking the thoracic spine and head with it.   Using the upper back muscles to hold the shoulder girdle in place also helps keep your spine in a neutral position – upright with only the natural curves associated with each spinal region.  In this respect, the large muscles of your upper back are considered postural support muscles and their strength helps protect you from getting back and neck discomfort.  

Another set of muscles we don’t usually associate with our backs is the abdominal muscles.  While these muscles are located clear around the other side of your body, they are important as both movers and supporters of your spine.  You have four layers of abdominal muscles.  The deepest layer is the transversus abdominis, which compresses or pulls the abdomen inward and connects to the lower spine for support.  The next two layers are the internal and external obliques, which compress your abdomen, bend and rotate your spine.  The outermost layer, the rectus abdominis, is what we see when someone has a “six pack” or very fit stomach muscles.  The inner three muscles are the most important to condition as they are the muscles which help stabilize/support the spine. 

Together, the abdominal muscles bend your spine forward, lean it sideways, twist your torso and rotate it side to side.  They also serve as a connection between your pelvis and your ribs, and when engaged properly can stabilize your pelvis to prevent excessive arching of the lower back.  Weak abdominal muscles often leads to low back pain but not just any sit-up will do. Exercises such as those performed in IMX Pilates workouts address the deep three layers in such a way as to condition them for postural support and back injury prevention.

Once you understand the basic structure and function of your spine and core muscles, you can work on achieving good posture, and a strong and healthy back!

References

Kapit, W., and Elson, L.M., The Anatomy Coloring Book.  New York: Harper Collins, 1977. 

Tortora, G.  Principles of Human Anatomy, fifth edition.  New York:  Harper & Row, 1989. 

Written by Elyse

by Elyse McNergney, MA, M.ED, Founder of IMX

Most doctors and physical therapists would agree that an integral component of a healthy spine is spinal stabilization exercise.  However, not all spinal stabilization programs accomplish the desired effect.  When movement patterns are faulty, or if extensor flexor ratios are not properly balanced for instance, spinal stabilization will not be achieved.  The goal of this article is to highlight the importance of stabilization exercise and to identify some important details for instructing your patients.

Stabilization exercise is a central aspect of spinal health.  The role of stabilization is to

·      Increase muscle mass in core muscle groups

·      Develop awareness of positioning

·      Improve muscle recruitment patterns

·      Create the proper technique from which all other exercises should be performed

Muscle Mass

Sad but true… all the muscles in the body atrophy without use after 25-30 years of age. The foundation of strength necessary to carry out simple activities such as lifting groceries or climbing stairs depends on the trunk muscle support.  When these muscles are weak or when they are simply inactive (meaning that the muscle recruitment is deficient); the result is  intervertebral compression  and shearing.  It is logical to conclude that the foundation of fitness is in the spine and the trunk muscles.  The trunk muscles not only support spinal movement but they also initiate all limb movement when functioning properly. Trunk muscle hypertrophy is necessary for spinal health and fitness and thus is a goal in stabilization exercise.

First let's identify the key trunk muscles that should remain fit throughout one’s lifetime. These muscles must be the target of stabilization exercise.  They include the Abdominal Wall, Deeper and Intermediate Spinal Muscles, Iliopsoas, and Pelvic Floor (PF). An exercise program that addresses the strength and coordination of these core muscles is essential for protecting the spine.

Posterior Trunk Muscles:

Deep Layer:

Semispinalis Capitis, Semispinalis Thoracis, Multifidus, Transversus Abdominis, Rotatores, Interspinalis, Inferior Oblique Capitis, Intercostals, Intertransversi, Quadratus Lumborum (Much of this layer connects vertebrae to vertebrae and lies underneath the erector spinae)

Intermediate Layer:

Longisimuss Capitus, Semispinalis Capitis, Splenius, Capitis and Cervicis, Serratus Posterior Superior, Iliocostalis, Longissimus, Spinalis, Serratus Posterior Inferior, Transversus Abdominis, External Oblique, Internal Oblique

Superficial Layer:

Trapezius, Latissimus Dorsi, Infraspinatus, Teres Minor and Major, External Oblique, Internal Oblique,

Anterior Trunk Muscles:

Pectoralis Major, Pectoralis Minor, Serratus Anterior, Rectus Abdominus, External Oblique, Internal Oblique, Transversus Abdominus, Diaphragm

Muscles of the Pelvis:

Gluteus Maximus, Gluteus Medius and Gluteus Minimus, Coccygeus, Iliococcygeus, Quadratus Lumborum, Piriformis, Iliopsoas, - Iliacus, Psoas Major, Psoas Minor and the Pelvic Floor - Urethra, Vagina, Rectum.

Decreases in muscle mass and strength as well as decreases in bone mass and intervertebral disc height are often a result of aging. Often times a patient withdraws from exercise programs because their pain increases after workouts. This is the start of a cycle of deconditioning and pain whereby the patient becomes less active and less fit. It is important that he/she be given a progressive stabilization program so that activities can resume without reinjury. For persons who do not receive proper stabilization therapy, denervation of key spinal support muscles occurs and is a precursor to severe deformities and fractures of the vertebral bodies (ie kyphosis).

Improving Proprioception

Stabilization exercise should also help the patient understand and improve spinal alignment. The three curves of the spine should be in balance for shock absorption.  Most people rotate the pelvis posteriorly and flatten the lumbar and cervical curves while performing exercises.  Stabilization exercise is used to reinstate these curves and develop strength to maintain proper curvature and alignment. The patient should understand that mobilization exercises can be used to increase flexibility at a joint; whereas stabilization exercise is used to strengthen the body in its correct position and co-contract the trunk muscles to build muscle fiber recruitment and endurance.

It is common that a patient will learn an exercise in the office only to repeat it at home with incorrect form.  Educating the patient to "feel" a new position as correct takes time and repetition.  This is why the exercises should be repeated in the office until the patient's neuromuscular system is re-educated.  Hands-on correction of minor errors is tedious but necessary.  For example, pelvic stabilization is comprised of an isometric muscle contraction of the Pelvic Floor (PF) and Transversus Abdominis (TrA) while maintaining an elongated neutral spine position. Many patients will use the gluteal instead of the PF and TrA muscles and posteriorly rotate the pelvic complex thus flattening the curve of the lumbar spine.  Without correction, this could further irritate soft tissues in the low back; and if repeated during weight bearing exercise may cause serious injury.

The goal of reviewing pelvic, thoracic and spine stabilization exercises is to improve the proprioception of the Spine Stabilization System and build core muscle support.  Your patient will reach a point of awareness where he/she is uncomfortable in the old postures and has fully integrated new postures. At this point you can progress his/her exercises without risk of injury. Abdominal and back strengthening exercises performed correctly will help the patient feel confident to resume an active lifestyle.  This is a process that varies for each individual and needs to be continuously evaluated by educated eyes.

Muscle Recruitment

The order in which the muscles "fire" to produce movement is now known to be dysfunctional in many patients with low back pain. The correct order of muscle recruitment for moving or exercising the lower and upper limbs begins with the Transversus Abdominis (TrA) followed by other trunk muscles and concluding with the limb muscles -- in other words, from the center to the periphery.  When a patient does not "fire" his/her muscles in the correct order, the spine is not protected from the loading produced by the movement (ie lifting). Exercise programs, such as pilates, can be designed to change dysfunctional muscle recruitment patterns (MRPs).

An important component to stabilization exercise is to analyze and develop MRPs so that they become more automatic for the patient. All exercises should begin with a contraction of the TrA and PF.  These muscles have been shown in research to work together and are effective for stabilizing the pelvis and low back (Sapsford and Hodges 1999).

In pilates programs clients are taught to stabilize before each and every movement. When performed correctly, pilates workouts develop trunk muscle endurance and tone, an important factor in the prevention of low back pain.

Recent research by Paul Hodges demonstrates that the diaphragm is not only a muscle used in breathing but is also a postural stabilizer.  Other research shows that the TrA, Internal Oblique (IO), and External Oblique (EO) will fire with a Forced Exhalation (also referred to as Deep Diaphragmatic Breathing); thus the breath is a key in triggering the muscles to "fire".  When teaching stabilization exercises the breathing is important in training trunk muscle recruitment.

The problem with many abdominal exercises is that they irritate soft tissue or increase compressive loading on the intervertebral discs.  For example - the common sit-up often causes high levels of compression in the lumbar spine.  In a study by McGill the safety of the sit-up was questioned because of the degree of tissue loading.  Load predictions from this study suggest that performing sit-ups (dynamic and quasi-static) result in compression loading (>3000 Newtons) on the low back. Repetitive sit-ups at high acceleration produced extremely high inertial loads and thus are prohibitive.   McGill also discovered that the straight leg sit-up does not significantly differ from the bent knee sit-ups in abdominal EMG activity or compression loading.

Create the Proper Technique

This brings me to the final point in this article -- CREATE THE PROPER TECHNIQUE and REINFORCE THE CORRECT MOVEMENT PATTERN so that the patient can and will perform all exercises correctly.  Obviously, we want our patients to be physically fit, but not if the exercises reinforce bad habits (movement patterns).  Unfortunately, this is usually the case.  How many times have you watched gym members perform abdominal curls incorrectly, (with too much momentum and pelvic movement) resulting in the  compressive force of a dozen backpacks upon the low back.  How many times have you seen a hamstring stretch performed as if it was a thoracic compression move?  How many patients do you know who can reach overhead without moving their cervical spine out of alignment?  Exercise programs should be formulated to correct faulty movement patterns and to create trunk stability, which is essential to a spinal stabilization program, and ultimately to your patients’ spinal health. Stabilization exercise supports spinal adjustments, soft tissue manipulation and muscle setting.  Learning to identify the details of correct stabilization is valuable to your back care practice! 

Elyse McNergney, MA, MEd, Certified Pilates Teacher, Certified Alexander Teacher.

Elyse is the founder of Integrated Movement Xercize (IM=X) also known as IMX Pilates.

Written by Elyse

by Elyse McNergney, MA, M.ED, Founder of IMX

Your spine is comprised of a series of small bones called vertebrae. The vertebrae are arranged vertically in a column, hence the term “spinal column” or “vertebral column.”  The spinal column is a very sophisticated structure that serves a number of functions.  It holds your body in the upright position, supports your head, and is where the ribs and the muscles and ligaments of your back attach.  It also encloses and protects your spinal cord, the part of your central nervous system that transmits messages back and forth between your brain and your body.   It is very strong and flexible, and is designed to move in a wide range of motions. 

The normal spine usually contains 33 vertebrae which fuse into a total of 26 bones.  The vertebrae are classified according to the segment of the spine in which they are located. 

The uppermost segment of the spine is in the neck region and is called the cervical spine.  There are 7 vertebrae in the cervical spine, and when viewed from the side, it has a slight forward or convex curve. 

The next segment is the thoracic spine, in the region of the upper back.  It has 12 vertebrae and a slight backward or concave curvature. 

Below the thoracic spine is the lumbar spine, or lower back, which has a convex curvature.  There are 5 lumbar vertebrae, which are the largest and strongest and support the most body weight.

The last two segments of the spinal column are the sacrum and coccyx, which have a convex curvature.  The sacrum is comprised of 5 sacral vertebrae that are fused into one bone.  Likewise, the last two to four coccygeal vertebrae fuse into one or two bones called the coccyx, or tailbone. 

The normal convex and concave curves of the spine are integral to structure and function.  They give the spinal column more strength than a perfectly straight structure would have.  They also absorb shock and help you balance.  Diminished, exaggerated, and abnormal spinal curvature can cause a wide range of physiological problems. 

Proper exercise should teach an elongated neutral spine without flattening the spine’s natural architecture (cervical, thoracic and lumbar curvatures). In IMX Pilates workouts clients are taught to “lengthen slightly beyond neutral spine” to achieve activation of the spinal support muscles and to avoid intervertebral compression during trunk loading (ie. Lifting weights). In other words as clients perform strength exercises they engage in the lengthening process to avoid injury to the spine. The combination of spinal elongation and core stabilize exercises as taught in the IMX Pilates technique is powerful back pain prevention.

References:

Hagen, P.T., ed.  Guide to Self-Care, second edition.  Mayo Clinic:  1999. 

Kapit, W., and Elson, L.M., The Anatomy Coloring Book.  New York: Harper Collins, 1977. 

Tortora, G.  Principles of Human Anatomy, fifth edition.  New York:  Harper & Row, 1989.