P R E S E N T E D B Y June 26, 2010 Why Core? Abdominal and Core for the Aging Spine Shari Kalkstein, B.A., PTA, HFS, CSCS, CPT, AHFS Before we address the topic of Abdominal and Core for the Aging Spine and delve into the fun exercises, several issues have to be addressed. For one, why are older adults in chronic pain and then why are core exercises important. Core exercises are often left out of older adult strength training programs. Unfortunately I see it all the time. Yet, with the degenerative aging process, this is the population that needs core strength training the most. August 4 8, 2010 Los Angeles, CA Chronic Pain Common Degenerative Changes I find older adults are in chronic pain because of a life time of developing muscular imbalances that were never addressed. They, simply are in chronic pain. Letʼs take into consideration career choices those that sat behind a desk, or over patients (dentists) are prone to develop flexed posture due to imbalances. Women who have had multiple pregnancies, abdominal surgeries are prone to muscle imbalances. These imbalances over a life time create a pain cycle that more then likely has never been properly addressed. Spinal Stenosis - occurs when the spinal canal becomes narrow; so narrow that the spinal cord and nerve roots get compressed. Compression leads to increase pain and decrease function. Spondylosis - known as spinal arthritis, is a side effect of aging that most people don't really want think about. It s degeneration (wear and tear) of the spine. After years of carrying the weight of your body, absorbing shock from movement, and dealing with the demands of daily life, your spine can start to show signs of wear and tear. Spondylolisthesis - Anterior or posterior slipping or displacement of one vertebra or another. Usually a result of again and stretched ligaments, but can be caused by a traumatic event as well. Scoliosis - Curvature of the spine in a S, usually caused by musculature imbalances over the years. Osteoporosis Osteoporosis When talking about the postural changes, osteoporosis cannot be ignored. As fractures occur, the spine starts collapsing on top of itself. This occurrence is due to compression fractures of the anterior body of the vertebrae's. This most often occurs in a flexed posture, spontaneously. Goal of an exercise program is to avoid flexion as much as possible. Keep in mind, they are already flexed, why do we want to 1) encouraged more flexion and 2) put them in a high risk fracture position. I personally do my best to keep my clients out of flexion. ADLʼs though must be taken into consideration, as making the bed, emptying the dishwasher, etc are all done in a flexed posture. So, educating them on modified ways to complete these critical ADLʼs are essential. Often called the silent disease as it depletes bone mass without symptoms and pain. Bones become fragile as they deteriorate, particularly the hip, spine, and wrist, but no bone is exempt. As bones weaken they can break, without warning.
Osteoporosis cont d Degenerative Changes Typically it is referred to as an old lady s disease. However, the bone losing process begins much earlier in life and doesn t reveal its ugliness until later years. This debilitating physical change can be prevented with early intervention; as early as starting in the pre-teen years. Pain and morning stiffness are common complaints regardless of the degenerative changes. Having clients do an array of simple bed ex s can usually alleviate pain ankle pumps, heel slides just the basics are enough to increase blood flow and decrease pain for those first steps out of bed. Sitting for prolonged periods of time may increase pain and other symptoms due to the compressional forces on the lumbar vertebrae. Ambulatory exercises work the best for these clients. Posture Changes Exercise Disclaimer!!! Newton s law states, things in motion stay in motion until an equal and opposite force is applied. Our job as fitness professionals is to apply an equal and opposite force to gravity and flexed posture by strengthening the spinal extensors to maintain an erect posture. Adults, in general spend a lot of time in a flexed posture; whether it be job related (dentist), sitting a desk/computer (almost every profession), or sitting in a recliner chair (retired). This has to be compensated for, otherwise the extensor musculature continue to weaken and a flexed posture continues - creating instability and postural associated pain. Exercises that elicit pain or increase existing pain must not be performed. Exercise during acute pain is harmful, except in those cases of back pain radiating to the leg or arm pain where the radiated pain improves with exercise. Poorly prescribed or executed exercises may aggravate patients' muscular instability. This is why not all patients should follow the same exercise plan: what may be indicated for one patient may be counter-productive for another. Guidelines for Exercise Abdominals and Back Exercises With any of the degenerative arthritic changes; any excessive movements can and will increase pain. The goal is to complete all land exercises, whether standing or lying, must be completed in neutral position or as close to whatever the client can achieve as long as they are pain free during exercise. Exercises completed in a standing position; staggered stance (my personal favorite) will provide the most functional activity. Guidelines for safe abdominal exercises Back is ALWAYS supported. The slower the better. All exercises MUST be done slow and controlled! Client MUST communicate with you NO pain, no gain is B.S. you NEVER want back pain with abdominal exercises. Start with very few repetitions endurance is developed over time, and NEVER rushed.
Defining Neutral Spine How to Find Neutral Spine Neutral spine is defined as the natural position of the spine when all body parts are in good alignment. In neutral spine, the body is able to function in its strongest, most balanced position. Neutral spine requires work to maintain! Even though it is the natural alignment of the body, most people have developed habits and imbalances that make it feel unnatural. Lie on the floor on your back. Bend your knees so that your feet are hip distance apart about 6-10 inches away from the back of the legs with your feet flat on the floor. Place the heels of your hands on the two bones on the front/top of the pelvis with your fingers over your lower abdominals. How to Find Neutral Spine, cont d Abdominals Without Flexion Using the muscles of the abdomen, rotate the pelvis so the lower back is flat on the floor. This is a posterior pelvic tilt. Release the posterior tilt and return the pelvis back to the starting point, then over-arch the low back in the opposite direction. This over-arch is an anterior pelvic tilt of the pelvis. Neutral spine is the relaxed position in between the two extremes pelvic tilts. The abdominal exercises selected for this presentation are geared towards the aging spine; taking into consideration most have some level of degeneration and/or osteoporosis. There is NO flexion or rotation. All exercises are completed in the best neutral spine the individual can achieve. Abdominal and core exercises without flexion are critical for stability and postural re-education. As well as developing and maintaining postural endurance. Abdominals and Back Exercises Lower Level Abdominals Guidelines for safe abdominal exercises Once neutral spine has been found, I can guarantee it cannot be maintained. Neutral spine is a concept that is learned over time, with constant verbal and tactile cues. Once in, as neutral position they can achieve, the next very critical aspect is setting the abdominals - bracing. This will keep the spine in a neutral position, otherwise a rocking of the pelvis will be noticed during exercise. Marching - this basic exercise introduces and teaches pelvic neutrality. Must be modified to the point Lower of success. Level Abdominals Toe Taps - takes Marches to the next level. Both of these exercises can be done in bed.
Mid-Level Abdominal Exercises NO FLEXION Bugs and Scissors are great introduction to coordinated Coordinated movements necessary Movements for developing a strong core. They are both fun and challenging at the same time. Both exercise combine upper body and lower body movement patterns for coordination and maximal use of core muscles. Everybody is familiar with the crunch exercise. This modification involves NO trunk flexion! The head, shoulders and hips remain on the floor at ALL time. Crunch Without Flexion This modification makes it safe for any/all degenerative spine conditions and osteoporosis. To follow along with the my principles and protocols the head shoulders and hips stay on the floor at all time! Planks Defining Core Stability Planks and Side Planks require strong abdominals and demonstrates a nice level of functional strength. Planks will NOT injure a spine, if pain exists, tweaking of body position will be necessary. I specifically teach hips to be slightly higher then the Upper Level Abdominals shoulders. I have found that most shoulder clients, whether impingements of rotator cuff or replacements can do front planks. However, I do not recommend side planks for shoulder involved clients. Since planks can be modified easily, they can be an affective exercise for any level of ability. Core stability is referred to the muscles that lie deep within the torso. The muscles of the torso stabilize the spine and provide a solid foundation for all other movements in the extremities. Weak core muscles lead to improper spine alignment and positioning and pain. Proper core exercises correct the imbalances and reduce uneven strains placed on the spine and reduces chronic pain. Strong core muscles reduces lingering, persistent back problems. Core Strength Training cont d Bridge With Unilateral Arm Movements To maximize the core muscles, use many body parts at the same time to teach coordinated movements. Encourage SLOW & CONTROLLED movements. Movements MUST be slow and controlled! Ankles dorsiflexed increase anterior tibialis muscle, necessary for normal walking. And, engages the glutes. Ball between knees help to stabilize hips and pelvic floor muscles. And, engages hip adductors and pelvic floor muscles when hips are in neutral position. Unilateral (weighted) arm movements to improve core strength and pelvic stability.
Erector Strengthening Stretches Great exercise that utilizes components of balance, strength Superman and coordination. Involves weight bearing of upper (great for osteoporosis) and lower body and necessary balance between the two. Goal is to hold each position for a 5 count. Then slowly return to starting position and repeat on other side. A key component to spinal stability and strength is appropriate flexibility. If muscle tightness is hindering proper alignment, no exercise will work effectively without improving flexibility. Stretches Key (but not only) muscle groups include: Hamstrings Glutes/Piriformis Quads/hip flexors Adductors Thank You Shari Kalkstein, B.A., PTA, HFS, CSCS, CPT, AHFS www.fortifyyourframe.com Fit4urlife@aol.com