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Tips for Maintaining Proper Spine Posture

Avoiding Bending, Lifting, or Twisting: Reminders for Appropriate Spine Positions

Dr. Bruce Witmer, MD

I’m often asked as a spine specialist what to avoid in regards to protecting the body from aggravation while engaging in all the fun and challenges of normal life. My typical rote response is simply: No bending, lifting or twisting. As I put more thought into this simple directive which has value as a quick reminder, I think furthering the discussion of spine protection is in order.

What makes up the spine?

Before clarifying what to do, let’s first look at what we are doing it to. That is, a quick review of what makes up the spine, or anatomy is helpful. The spine has four main components: bones, discs, nerves and ligaments.

The bones of the spine or vertebrae are the main structural supporting body. Calcium rich, these bones are the strong matrix providing for protection of what lies beneath, or within the spine, the nerves. With openings centrally, the canal and to the side, foramen, the nerves can pass from the control centers of the brain and spinal cord to the action centers of the muscle and skin. These are very strong and protective, but also quite rigid. To encase the nerves for maximal protection, these vertebral bones form a ring around them.

Stacked one on top of another, the vertebrae twist and bend based on the discs that rest between them. These cartilaginous, soft and spongy structures allow for separation of the bones and with their elasticity, provide for the spines ability to flex or angle, allowing for greater functionality. The outer disc or annulus fibrosis is the strongest layer and rests on the perimeter, closest to the nerves. Inside of this annulus is the nucleus pulposus. This gel-like material is less rigid, in fact soft in nature, allowing for even more in the way of flexibility and impact or shock absorption.

The nerves are central to and encased within the bones and adjacent to the discs. Starting from the brain, the nerves traverse the stacked vertebrae, top to bottom, some pairs exiting at each subsequent layer down. The ligaments are tough cartilage strands that lie along the sides or are intertwined among bones and discs of the spine. Muscles of varied lengths, while technically outside of the spine proper provide beams, or columns of support for all of the above structures.

What happens when we overstress or over impact the spine?

While the bones are rather rigid and resistant to impact, they do have a breaking point, literally. A fracture is rare and most commonly is portended by osteoporosis, or decalcification of the bony matrix. The bone, with enough downward impact can compress causing the appearance of a wedge. Higher velocity or force of impact can lead to the bone spreading or breaking of the ring into what’s known as a burst fracture.

The above situations are rare as the spine has a built in protection, or shock absorber for the bone in the form of a disc above and below each vertebra. Like the bones however, the disc has a breaking, or at least, a bulging point. Whereas the bone may collapse, compress or burst with too much force, the disc itself might bulge, protrude, extrude or herniate. This process can be abrupt but usually occurs over time through a process of wear. First to change with wear is the outer disc ring or annulus. Once this is stretched or fissured, the nuclear material is free to escape from the inside to out. In doing so, it can occupy space closer to or encroach upon the nerves adjacent.

How do we most safely utilize the spine?

No bending, lifting, or twisting. While this dictum could possibly be adhered to by a small minority, the reality is that most of us can at best modify how we approach life’s daily requirements.

In approaching our daily tasks correctly from the spine’s perspective some postural cues are helpful. First, the spine discs should be recognized and appreciated for what they do: shock absorb. As such, wear and tear is likely, the end result being pain by way of leakage of chemicals from within the disc. The resulting excessive inflammation irritates nerves driving pain and spasms. To adequately protect the spine from this cascade, avoidance of impact, aligning correctly and strengthening the adjacent muscular beams of support is paramount.

What are the most appropriate spine positions?

A visual for alignment would be attempting to retract shoulder blades in a fashion where they nearly touch as they close in on the spine. Notice how excessive thoracic kyphosis or bend is now reduced, which results in a more appropriate neck angle of chin retraction and neck lengthening.

Another great visual reminder is to picture your spine as an accordion, where too much squeeze causes too much pressure. The pressure in turn drives disc leakage, inflammation and pain. As such, all daily activities can try to adhere to less downward pressure or twisting motions.

What types of physical activity are best from the spine’s perspective?

Finally, workouts and fitness routines should adhere to principles of low impact. At each opportunity the patient should trade out the higher impact training in favor of lesser. Treadmill may be less impact than pavement walking. Flat trails may be less impact than hill climbing. Aquatic training may be less impact than ground or weight based training. Squats, cleans and jerks are tougher on spine angles, whereas leg sleds with the spine in a supported neutral position is preferable.