What exercise is best for spinal health

I get asked all of the time from patients what exercise routine is the best to follow to help their back problems. It is then usually assumed that they need to be doing Yoga or Pilates to maintain good spinal health. So is it true?

Difference Between Exercise and Therapeutic Exercise


The truth is that there is no perfect exercise routine that will fix all your problems unless you know what the problems are. That being what are your restrictions and limitations in range of motion, strength, agility, or endurance wise that are setting you up for injury? 

This means you need to be more in touch with your own body and pay attention to your limitations. Do you have range of motion limitations that would show up with the self tests on the main page of this site? If so then you need to work on restoring the range of motion. Yoga could be beneficial for this but only if you pay attention to the poses in which you struggle and work to improve your form and break through the restrictions. If you only work within your limitations then nothing changes. So if certain poses are hard for you then you have to figure out why. Where are you missing range of motion at in order to get into the position? Where are you weak so that you cannot maintain the position? Are you having to compensate to get into the position and now you cannot maintain good breathing mechanics while holding the position? These are things you must ask yourself and figure out either on your own or with the help of a good instructor to turn a Yoga workout from mere exercise into therapeutic exercise. 

This is not limited to Yoga. It can be done with any routine. Yoga is an easy example but it can also be done with weight lifting where you can find a lot of good information at the MobilityWOD website for self testing and correction strategies to free up range of motion to be able to perform Olympic lifts that require a high degree of motion, strength and stability. It can be done with a simple calisthenics program where you need to pay attention to whether or not you can maintain a neutral spine position throughout the workout. If not you have restrictions and limitations that need to be addressed. Once again the self tests on this site will get you started towards figuring those limitations out but if you get stuck and cannot break through them on your own you likely need a trainer/coach/movement specialist that is trained in this very area of understanding movement.

Exercises that should never be part of your workout


There are however many exercises that have become very popular over the years and consistently find their way into routines that will set you up for injury. Some of them you might find very shocking.

Sit-ups
The first is sit-ups. Sit-ups are absolutely horrible and serve no functional purpose in exercise or movement at all. But they strengthen my core, right? Wrong! This exercise strengthens your rectus abdominis and your iliopsoas primarily. The reason this is bad is because the primary function of your rectus abdominis is to flex your spine. Flexion is a position of weakness for your spine so we don't want to overly strengthen the muscle that puts you in that compromised position. In fact when I check this muscle it is almost always too tight and strong. Not weak. With the iliopsoas we have a similar issue in that it is also almost always too tight and strong and this particular muscle actually attaches into the lumbar spine discs so if it is too developed and strong can lead to high amounts of shear force and disc herniations. Last when these two muscles are overdeveloped they inhibit your low back spinal stabilizers. That's right the very muscles that attach directly to the spine for stability can be completely turned off by the excessive firing of these muscles.

So this exercise should be avoided whenever possible. It is very unfortunate that it is still a standard of testing for physical ability in the military, but that doesn't mean you have to train it to be able to pass your test. In fact not training it and focussing on the spinal stabilizers instead while keeping the rectus abdominis and iliopsoas released can actually help your sit-ups testing. For one having spinal neutrality (good posture) will allow you to engage the abdominals better during your test than if they are already partially contracted. Secondly you are less likely to end up in pain that will cut down on your overall performance and hinder your remaining events.

Leg lifts, crunches, flutter kicks, in and outs, V-sits, etc.
Based on the same premise as cutting out sit-ups you want to eliminate any exercise where you are training muscles to flex your spine. Now some people have enough flexibility and can elicit the proper spinal stabilizers correctly to perform some of these exercises without the spinal flexion and overtraining of the spinal flexors but for most people these exercises only cause dysfunction and therefore should be avoided. Instead train your abdominals to do what they were designed for which is stabilizing. Perform stabilization exercises such as planks, side planks, dragon flags, human flags, front levers, etc. that force you to engage your abdominals while holding a neutral spinal position. Complex strengthening exercises also train the muscles this way as you have to be able to engage your abdominals to perform a standing overhead press for instance or a proper deadlift. Where people get into trouble is that they have been training their core to flex their spine for so long that when they try to do a complex lifting exercise they fire their core, flex their spine and end up very hurt. This is why many people avoid these exercises that can be very good for you as you develop the ability to keep your spine neutral.

One last thought
So after understanding all of this and the piles of research that support this information it is really amazing to me that when I look at group training sessions such as command PT programs in the military or bootcamp programs on the civilian side you will consistently not only see these horrible exercises but see them implemented at the beginning of programs followed by complex exercises that require high amounts of stability. So they not only train the muscles incorrectly and turn off the spinal stabilizers in doing so they follow it up by doing exercises that require high levels of spinal stabilization. And they wonder why people get hurt...

Be smart! Train Smart!

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