Spinal Alignment and Function

Spinal Alignment and Function

Before addressing mobility deficits, movement prep, integrated movement, and functional strength training, it is important to first address what normal spinal alignment and movement/motion is.

Spinal Alignment:
Convex/Lordotic Curvature
? cervical spine (C1-C7)
? lumbar spine (L1-L5)

Concave/Kyphotic Curvature
? thoracic spine (T1-T12)
? sacrum (S1-S5-fused)
? coccyx (4 fused vertebrae)

Spinal Movements/Motions(1.):
1. Rotational Movements: change in orientation of vertebrae around an axis
2. Translational Movements: no change in orientation of vertebrae, movement of whole vertebrae
3. Coupling Motion: multiple movements occurring simultaneously

Cervical Spine:
? Nodding head (flexion/extension)
? Axial rotation/torsion
? Lateral flexion

Thoracic Spine:
? Coordinated movement of ribcage/vertebral segments
? Respiration: ribs moving upwards, sideways, and forwards
? Flexion, anterior translation, extension, posterior translation
? Type 1 coupling motion (T6-T-12): rotation and lateral flexion in opposite directions (2a.)
? Type 2 coupling motion (T1-T5): rotation and lateral flexion in the same direction (2b.)

Lumbar Spine:
? Optimal for spinal extension and flexion
? Lumbar stiffness (via intra-abdominal pressure)
? Limited lateral flexion and rotation capabilities
? Minimal mobility in transverse plane

Pathological Spinal Curvatures, Posterior Chain/Anterior Chain
Spinal curvature disorders are fairly common and are typically a result of poor posture, which are fairly simple to treat with rehab/corrective exercises, chiropractic adjustments, and manual therapy. Working for Sport & Spine Rehab in Columbia, MD as a rehab specialist, and I can tell you we see this quite often, and fortunately for our patients/athletes, they get fixed quite fast. At Sport & Spine Rehab, we use FunHab(3.) or Functional Rehabilitation, for getting patients not only out of pain, but at their greatest level of function. Now, there are pathological curvatures also caused by age related/arthritic degeneration, a developmental condition, or traumatic injury. We just reviewed how normal spinal curves consist of both lordotic and kyphotic curves, but, these curves unfortunately can be altered. Using poor posture as an example, sitting can induce hyper-lordosis (excessive inward curvature) of cervical spine, and hyper-kyphosis (excessive outward curvature) of thoracic spine. Sitting on a chair, with a hunched back/rounded shoulders, while typing with a laptop on the thighs for extensive periods of time, over many months, can cause the body to shift forward, placing excessive stress on the posterior chain or back of body (muscles of the back of neck/torso/thighs) and anterior chain or front of body (muscles of the front of neck/torso/thighs). Other spinal disorders can such as scoliosis (S or C shaped spinal curvature), spinal stenosis (cervical or lumbar spinal canal narrowing), spondylosis (narrowing of facet joint causing associated nerve root impingement), spondylolisthesis (annulus damage, lumbar vertebrae slipping forward), and lastly, osteoporosis (fragile vertebrae) are disorders which will require a medical professionals intervention, but, typically can also be treated with chiropractic and physical therapy care.

Pathological Pelvic Tilts, Lower Crossed Syndrome, Hip Abduction Dysfunction
Imagine your pelvis as a bucket of water. A normal/neutral pelvis doesn’t tilt too far forwards (anteriorly) or too far backwards (posteriorly). When something known as ?Lower Crossed Syndrome? is present, that means an anterior pelvic tilt has developed, which ?spills the water? forward. The opposite can occur, when the water spills backwards because of a posterior pelvic tilt. Unfortunately, these pathological pelvic positions can cause altered movement patterns simply because certain muscles are tight/overactive, and others weak/inactive. For example, Hip Abduction Dysfunction is when the outside gluteual muscles/hip abductors, are weak because of overactive groin muscles (anterior chain), the ipsilateral/same side low back muscles will overwork for the weak hip abductors, which then causes low back pain (posterior chain). This muscle imbalance will have a kinetic chain ripple effect, causing altered gait due to ?hip hiking? or, premature activation of low back muscles, due to the weak hip abductors. Lower Crossed Syndrome acts in the same way as Hip Abduction Dysfunction, in that because of the tight and weak anterior chain muscles, mainly tight hip flexors and weak core, and tight and weak posterior chain low back extensors and glutes. The low back has to do more work because of the lack of hamstring/glute strength, causing dysfunctional hip extension (inability to extend leg straight back) and lower back pain.

Performance Pyramid
The base which people should build their gross athleticism, and performance on is, optimal movement. Optimal movement is achieved by having symmetrical mobility and stability through the entire ?kinetic chain? or, systemic flexibility, and motor control through the whole body. Based on the Functional Movement System’s ?FMS Performance Pyramid: movement, performance, skill?(4a.) any person looking to increase their skill/performance for a sport, and/or even for just activities of daily living need to have functional movement being worked on before, or during higher levels of training (strength, power etc.). Being able to produce movement/force without ?energy leaks?, or compensatory movement expelling excessive energy (skillful compensation), will allow for safer, more powerful, and more efficient force transfer, as well as less energy spent! As a certified level 2 FMS Specialist, I have seen many patients/athletes benefit from getting movement screened, and scored on their movement patterns. Being able to identify weaknesses and asymmetrical patterns is paramount for developing corrective strategies for enhanced performance.

There tend to be two categories(4b.) of performance issues associated with athletes movement scores
1. The Underpowered Athlete: good overall movement scores (except for a bad high motor control score), symmetrically mobile/flexible, but lack relative strength and power, and need increased stability/strength/power without altering movement scores
2. The Overpowered Athlete: bad overall movement scores (except for a good high motor control score) good force/power production, skillful compensation, great stretch- shortening/proprioception-plyometric capacity(5.), great strength/power and need increased mobility/flexibility, and steady reevaluation of movement screens

I highly recommend everyone visit the FMS website. Check out all the great articles/research behind the screens; which professional teams/athletes benefited from it, and it’s just a great resource for anyone looking to learn more about the paradigm shift occurring in fitness and athletic development! So, in part 2, local and global core exercises were discussed and those exercises fit into the mobility/stability portion of the performance pyramid.

Soft Tissue Treatment
For self care of soft tissue treatment of myofascial trigger points/adhesions/fibrotic tissue; self myofascial release with a foam roller is excellent. Foam rolling helps to inhibit overactive tissues via autogenic inhibition. It does not activate the myotatic reflex, which causes reduced force production(6.a), and it doesn’t cause local ischemia or reduced blood flow to the muscle(6.b), like average static stretching does, which makes foam rolling the gold standard for pre-workout stretching:

? ?Athletes could try foam rolling pre-workout to improve joint range-of-motion (ROM) without the risk of reducing neuromuscular performance in either high-force-low-velocity or high- velocity-low-force muscular actions, as can occur with static stretching.? -By, Chris Beardsley. Chris Beardsley is a sports scientist specialising in lower body biomechanics. He writes the monthly Strength and Conditioning Research Review service. (6.c)

Here are some other benefits of foam rolling(6.d): reduced arterial stiffness, improved arterial function, and improved vascular endothelial function for improved cardiovascular health, long-term exercise recovery, short-term exercise recovery. A medical professional can provide even further soft tissue treatment with manual therapy, graston technique, low level laser therapy, ultrasound, dry needling, and my personal favorite, active release technique (A.R.T.). Now, it is time to go over the advanced stability exercises for the cervico-thoracic and lumbo-pelvic regions, and global mobility/movement prep/integrated movement and functional training portion! Enjoy!

Mobility, Movement Prep, Integrated Movement, Functional Strength Training
Lower/Upper Extremity Mobility
Triplanar Groin
Triplanar Hip
Anterior Chain/Lateral Line Mobility
Lateral Hip Distraction (Impingement Clearing) + Latissimus Mobility
Posterior Chain Mobility
External Rotators, Quadriceps (piriformis/glutes)

Ankle Dorsiflexion 1
Ankle Dorsiflexion 2

Movement Prep
Spine Prep:
Hip Hinge Series 1
Hip Hinge Series 2

Cervico-Thoracic Prep:
Fascial Arm Line Opener
Shoulder Complex
? Side Split w/ Thoracic Rotation
Anterior Chain Prep #1
Anterior Chain Prep #2

Lumbo-Pelvic Prep:
Cook Hip Lift (glutes)
Posterior Chain Prep #1
Posterior Chain Prep #2
Hip Abductor Prep

Integrated Movement
Squat To Stand Series
Drop Squat Series
? Kneeling Inline Stability Press #1

Functional Strength Training
Anterior Knee Dominant: 1 Arm Rotational Squats
Horizontal Pull: Inverted Row

Posterior Hip Dominant: Pull-Throughs (hip hinge)
Horizontal Push: Upright 1 Arm Cable Press

Single Leg Posterior Chain: Contralateral Deadlifts
Horizontal Pull: Upright 1 Arm Cable Pull
Standing Sumo Stance Stability Press #2

Single Leg Anterior Chain: Heel Taps
Vertical Press: Contralateral Presses
Vertical Pull: Pull Up Regression

Brandon McCary
Sport and Spine Rehab
Rehab Specialist, Columbia MD

“To be the trusted leader in enriching the health and well being of the public, one life at a time.”For more info on Sport and Spine Rehab, please visit our website at www.ssrehab.com.

References:
1. (1.) http://www.spinerf.org/sites/default/files/journal/Banton%20Biomechanics.pdf
2. (2a-b.) http://www.grayinstitute.com/articles.aspx?Article=27
3. (3.) http://www.tihcij.com/Articles/FUNHAB-A-Science-based-Multimodal-Approach-for- Musculoskeletal-Conditions.aspx?id=0000399
4. (4a-b.) http://www.functionalmovement.com/articles/Screening/2010-06- 08_athletes_and_the_fms
5. (5.) http://www.functionalpathtrainingblog.com/2013/04/performance-paradigm.html
6. (6a-d.) http://www.strengthandconditioningresearch.com/2013/10/01/foam-rolling/

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