All About Spinal Health

What’s the #1 reason people visit the family doc? The common cold.
What’s the #2 reason? Lower back pain.
80% of adults report lower back pain at some point in their lives and 10-15%
of all sports-related injuries involve the spine. Low back pain accounts for
more lost person hours than any other type of occupational injury and is the
most frequent cause of activity limitation in those under age 45.
Thus, it’s important to understand what the spine is, what it does, and —
most importantly — how we can keep it healthy.

What is the spine?

Along with opposable thumbs that we can use to work the TV remotes we
invented, one of the things that distinguishes us from many other animals is our
spine. The spine provides structural support for our bodies, protection for our
central nerves, and facilitates locomotion (aka movement).
The spine is made up of 24 semi-rigid presacral vertebrae (seven cervical,
twelve thoracic, five lumbar) separated by discs. Five sacral vertebrae fuse to
make up the sacrum, which helps transfer upper body weight to the pelvis through
the sacroiliac joint. The coccyx (tailbone) makes up the bottom of the vertebral

The natural curves of the spine
Intervertebral discs hold vertebrae together, act as shock absorbers, and
allow dynamic spinal movement. These discs measure around one centimetre in
height and consist of a gooey center (nucleus pulposus) surrounded by connective
tissue (annulus fibrosis). (Think of an Oreo with the disc as the filling and
the vertebrae as the hard cookies.)

Bony projections come together along your mid-back to form the spinous
process, which you can feel and see.

The cervical spinous process
Ligaments run along the spine and provide stability, helping the spine
protect nerves extending from brain to body.

Spinal muscles and their roles

Several muscle groups attach to the spine or play a critical role in spinal
health. Problems with these muscles can cause back pain. (For more on how this
works, see the next section.)

1. Iliopsoas (psoas + iliacus) complex

These lie deep within the abdomen and hip, connecting the lumbar vertebrae
and the iliac crest to the top of the femur. They’re major movers during bent
knee leg raises and sit ups.
Aggravated with: Lots of sitting/driving, lots of kicking (martial arts or
soccer), long bike rides in bent position, and sleeping in the fetal

2. Paraspinals

These are like the spine’s “suspenders” and help to control rotation,
extension and bending. This group includes the erector spinae and multifidus
along the spine.
Aggravated with: Sudden spinal overload, repetitive movement with poor
technique, hunched posture, tight abdominal muscles, and lots of sitting.

3. Rectus abdominis

This sheet of muscle is your “washboard abs”. It runs between the lowest ribs
and top of the pubic bone, and helps stabilize the torso. Excessive training of
the rectus abdominis (at the expense of posterior chain muscles) can diminish
the ability to carry weight overhead (think jerks, snatches, overhead presses)
and lead to lower back injury. So: fewer crunches, more swings.
Aggravated with: Too many crunches (especially without posterior chain
training), over-exercising, excess abdominal fat, reliance on weight training

4. Gluteus group: maximus/medius/minimus

Aka the booty, these are the muscles that help bring your thigh behind you
(think: donkey kicks), rotate it, and bring it to the side.
Aggravated with: Prolonged sitting, sleeping in fetal position with knees
pulled up, sitting on your wallet, standing for long periods on one leg,
sleeping on your back with feet splayed under the weight of a heavy blanket.

5. Piriformis

This small muscle lies deep within the glutes and connects the thigh to the
pelvis near the sacrum. It rotates the thigh outward and swings the leg to the
side when the thigh is flexed.
Aggravated with: Distance running (repetitive overuse in general), prolonged
contraction (such as driving a car), sitting with one foot underneath you,
walking with duck feet (toes out), sitting too much.

6. Quadratus lumborum

The “QL” lies deep in the side of the torso around the kidneys. It helps to
bend, rotate, and straighten the torso from bent position. It also helps with
exhalation (coughing, etc.), which many folks discover when they strain the QL
and then live in fear of sneezing.
Aggravated with: Structural imbalances (one leg longer, uneven pelvis, etc.),
habitual leaning to one side, slouching, always sleeping on one side.

7. Hamstrings

These big leg muscles run along the back of the thighs, attaching at the hip
and the knee. They bend and stabilize the knee.
Aggravated with: Pressure from chairs, prolonged sitting, bed rest, overload
(e.g. lots of sprints when a trainee isn’t used to sprinting).

8. Soleus

This deep calf muscle assists with walking, jumping, and pointing the toes.
When irritated, pain can radiate to the sacrum.
Aggravated with: High heeled shoes, rigid/tight shoes, bedding that weighs
down toes, standing still for extended periods, prolonged driving, sitting on
chair that is too high (so the feet don’t touch the floor).

What can lead to spinal problems?

Usually, spinal problems are multifactorial. Predisposing factors
  • Poor mobility in surrounding muscles
  • Bad biomchanics
  • Poor posture
  • Weakness of supporting musculature
  • Muscle imbalances
  • Sedentary lifestyle, sitting, and immobility

Poor mobility in surrounding muscles

The pelvis is the foundation for the spine. Decreased mobility in the hips,
hamstrings, ankles, and thoracic spine can lead to overcompensation at the
lumbar spine and excessive pelvic tilt. This problem is particularly common in
women — in part because of higher heels, but also because the connective tissues
of an average woman’s spine are usually looser than the average man’s.

Bad biomechanics

Back pain only gets worse with poor biomechanics.
Most spine injuries that occur during training are muscle strains or ligament
sprains, usually due to improper loading and technique. A common error is lumbar
flexion during movements like good mornings, situps, deadlifts, and rows.
Excessive lumbar extension is also dangerous and can lead to vertebral fracture
(e.g., finishing a heavy deadlift).
The safest position for the lumbar spine is a neutral position — a natural
but not exaggerated S-curve (double check the spine image at the top of this
article for reference). You can find a neutral spine by flexing your lumbar
spine, then extending it and trying to find the midpoint between the two, or by
standing tall and taking a deep breath. Use a mirror to check.

Nice neutral spine

My disc just herniated looking at this picture (too
much spinal flexion)
It’s important to get good at the movements you regularly do. If you’re
always lunging and twisting for martial arts or your plumbing job, get good at
lunging and twisting. Don’t just go home at night and do situps hoping to
preserve your back.

Poor posture

If your posture sucks, your back sucks.

Poor posture means higher levels of shear stress on the spine. When posture
is appropriate (proud chest, natural lumbar curve, tight core, retracted
shoulder blades, etc.) – then we’re able to handle higher amounts of compressive
force. Oh, a big gut and high heeled shoes can negatively influence posture. Try
to avoid one or both as much as possible.


Many people assume that strong abs help them bend and twist. This is true, in
part, but most often the core’s role is stability rather than movement — in
other words, preventing motion rather than initiating it. Too much flexion or
extension at the lumbar spine, usually caused by weak core muscles, can lead to
injury. It’s also biomechanically weaker. You can throw a lot farther or punch a
lot harder when your hips and shoulders are involved than when you’re just
twisting at the waist.
Reliance on weight lifting belts can lead to torso stiffness and


Folks with chronic back pain often neglect the posterior chain (i.e. the
muscles that run along the rear of the body from neck to ankles). This is
especially true for gym rats who do too much bench pressing and not enough
pulling or hip extension. This keeps back problems in full force (plus said gym
rats end up looking like light bulbs).
Single leg exercises help develop the lower body and immediately challenge
the lower back and hips, building stability and function. We tend to be weak and
imbalanced on extension movements because we do them less.

Not moving

Doctors used to recommend bed rest for back pain. Now they usually recommend
movement. And, as you can see from the list of muscle problems above, “too much
sitting” factors into a host of back problems.
When we sit or lie around all day, intervertebral discs absorb fluid and
become tighter, allowing less range of motion and promoting injury. Introduce
yourself to regular movement (warm ups, yoga, and dynamic joint mobility, along
with walking and swimming). These all help to preserve spinal health. See
All About Warming Up
About Yoga

All About Dynamic Joint Mobility

Other common problems


A collection of spinal dysfunctions known as the “spondys” can result from
spinal fracture, overtraining, and/or over-extension/twisting of the spine.
They’re common, for instance, in gymnasts and yogis who repeatedly bend
backwards. They can also occur acutely in high-impact sports such as rugby.
  • Spondylitis is an inflammation of the vertebrae.
  • Spondylosis is osteoarthritic narrowing of the vertebral space.
  • Spondylolysis is a fracture, usually a stress fracture, of the pars
    interarticularis. It can lead to a spondylolisthesis.
  • Spondylolisthesis, which can occur after a spondylolysis, is the forward
    slippage of one vertebrae on another. Think of a stack of books in which one
    book is pushed forward.
Excessive flexion, extension and rotation are bad news for anyone with
spondylo-situations. Work on building mobility of the hip flexors, hamstrings
and ITB.

Prolapsed disc

This occurs when intervertebral disc material bulges from its normal
confines. Minor tears to the outside of discs can lead to inner disc
The key is to never let the problem start. Translation: build core

Treating and preventing spinal dysfunction

Get moving

As mentioned above, movement is good, and inactivity can cause/exacerbate
back pain.
  • Resistance training helps build strength and endurance in the supporting
    musculature, and help activate weaker or inhibited areas.
  • Mobility training helps improve active flexibility in tight areas.
  • The intervertebral discs lack blood vessels. The only way they can absorb
    nutrients is through spinal movement. If you want to deprive your discs of
    nourishment, lie down and sit around a lot.
But before you randomly start lifting, running, twisting and jumping, think
WWDMD (What Would Dr. McGill Do)? Spine biomechanicist Dr. Stuart McGill
encourages the following approach when it comes to exercise design:
  1. Do necessary corrective exercises
  2. Groove appropriate movement patterns
  3. Build full body joint mobility/stability
  4. Increase core endurance (rather than maximal strength)
  5. Build full body strength
  6. Develop speed, power, and agility
How many people do you know that start at #1?

Spines & squatting

Squatting with poor mechanics will result in injury.
Squatting with added weight puts compressive forces on the spine. Why don’t
we see more spinal blowouts at the gym? Luckily, our spine can adapt to
compressive tolerance. But our spines need time to adapt. Take your time and
allow this adaptation. To assist the process, build up your paraspinal muscles
with exercises involving spinal extension and stabilization.
Double check squat form:
  • Take a wider stance (at least shoulder width – if not wider)
  • Use natural foot positioning (similar to other athletic movements)
  • Keep heels in contact with the floor
  • Gaze forward or slightly up
  • Maintain lordotic curve in lower back — don’t round
  • If back squats don’t work, try front, zercher and goblet squats
  • Focus on hip extension — drive from the glutes and hips.

Intra-abdominal pressure (IAP) can help to stabilize the spine during squats.
Momentarily stopping the breath and stiffening the abs to make the spine go
rigid (think of what you do when you sneeze, or when you know someone is about
to punch you in the gut — if you make a little “ungh” sound, you’re probably
doing it right) will generate IAP.

Stabilizing the cervical spine

Neck muscles work isometrically to stabilize the cervical spine. A stable
cervical spine is critical for contact sports. Thus, folks with greater
musculature in the neck and shoulders have a better chance of withstanding
cervical impact.
Forcing the cervical spine into excessive flexion or extension with
resistance can lead to breakdown of joints and discs.
To build the cervical spine, try incorporating the following exercises. Hold
for 10 seconds each, and do 1-5 sets:
  1. Isometric neck flexion (forwards)
  2. Isometric neck extension (backwards)
  3. Isometric lateral neck flexion (right and left)
  4. Isometric neck rotation (right and left)

Mobility warmup

Here are some sample mobility drills that can keep the spine mobile yet
stable in all the right places.
Cat/cow spinal warm up

Foam roll the thoracic region (from 1:30 to 2:10 in

Thoracic mobilization

T push up

Stretch hip flexors

Reverse bridge with back on Swiss ball (for intermediate and
advanced folks, begin alternating legs “marching”)

Squat to stand with reach

Finishing with spinal health movements

To promote spinal health, add some of the following to the end of your

McGill curl-up

Stir the pot

Side bridge

Bird dog (move the leg and arm laterally to make it

Pallof presses

TRX back saver (from 0:58 to 1:40 in video)

To promote spinal health, try the following between workouts.
Instead of bending at the lumbar spine to pick something up from the ground,
try the golfers pick up (unilateral deadlift):

Instead of squatting to get down on the floor, try going into a lunge and
keeping your spine neutral.

Mix in some yoga

Yoga may help improve posture through development of extensor muscles and
thoracic mobility. Vinyasa yoga is likely the best option for back health due to
its dynamic nature. Try to focus on a neutral spine when statically


Standing on an unstable surface (like a balance board) recruits stabilization
While on this surface, assume a position of slight knee and hip bend while
contracting the lower torso muscles. Then flex your arms in an alternating
fashion while maintaining position. Try this for 1 minute, 2-5 times through. If
this doesn’t help your spine, at least you’ll now be known as the balancing
flailing loser in your neighbourhood.

Source: Kolber MJ & Beekhuizen K. Lumbar stabilization: An evidence-based
approach for the athlete with low back pain. Strength Cond J 2007;29:26-37.

Summary and recommendations

Spinal health comes from a complex interplay of mobility in some areas and
stability-strength-endurance in others. Many muscle groups are related to spinal
health — ensure that you aren’t prioritizing the “beach muscles” (aka chest and
abs) over the more important structural supporters like spinal extensors and
Sitting is bad news for your spine. Get up and move. If you’re always sitting
around, take time to get up, walk, bike, and stretch. Do what feels good and
listen to your body.

Extra credit

Between ages 7 and 17 years, the spine can increase in length by about
Only performing “aerobic” workouts doesn’t seem to build spinal
Tightness in the ITB and piriformis can limit pelvic movement.
Spinal compression is high during situps.
Lumbar flexibility tends to increase throughout the day.
Lateral deviation of the spine is known as scoliosis (when viewed from the
Using a Bodyblade correctly can actually enhance core stability

Further resources

Dr. Stuart McGill and

Exercises for low back pain


Schoenfeld BJ. Squatting kinematics and kinetics and their application to
exercise performance. J Strength Cond Res 2010;24:3497-3506.
Lee J, Brook S, Daniel C. Back Pain – the facts. 2009. Oxford University
Manire JT, et al. Diurnal variation of hamstring and lumbar flexibility. J
Strength Cond Res 2010;24:1464-1471.
Kell RT & Asmundson GJG. A comparison of two forms of periodized exercise
rehabilitation programs in the management of chronic nonspecific low-back pain.
J Strength Cond Res 2009;23:513-523.
Sauer S & Biancalana M. Trigger point therapy for low back pain. 2010.
New Harbinger Publications.
Kolber MJ & Fiebert IM. Addressing flexibility of the rectus femoris in
the athlete with low back pain. Strength Cond J 2005;27:66-73.
Howley ET & Franks BD. Health Fitness Instructor’s Handbook.
4th Ed. 2003. Human Kinetics.
Lower Back Savers Part 1:
Lower Back Savers Part 2:
Lower Back Savers Part 3:
Kollias H. Core Values: Preventing back pain. Precision Nutrition.
Durstine JL & Moore GE. ACSM’s exercise management for persons with
chronic diseases and disabilities. 2nd Ed. 2003. Human Kinetics.
Durall CJ & Manske RC. Avoiding lumbar spine injury during resistance
training. Strength Cond J 2005;27:64-72.
Ashton-Miller JA & Schultz AB. Biomechanics of the human spine and trunk.
Exerc Sport Sci Rev 1988;16:169-204.
McGill SM, et al. Exercises for the torso performed in a standing posture:
spine and hip motion and motor patterns and spine load. J Strength Cond Res
McGill S. Core training: Evidence translating to better performance and
injury prevention. Strength Cond J 2010;32:33-47.
McGill SM. Low back stability: From formal description to issues for
performance and rehabilitation. Exerc Sport Sci Rev 2001;29:26-31.
Kolber MJ & Beekhuizen K. Lumbar stabilization: An evidence-based
approach for the athlete with low back pain. Strength Cond J 2007;29:26-37.
Ross MD. Preventing low back pain with athlete education and the prone
press-up exercise. Strength Cond J 2007;29:78-80.
Harper TD. Protecting the spine during static stretching. Strength Cond J
Robinson EM. Overtraining the rectus abdominis can make you less efficient in
weightlifting. Strength Cond J 2010:32:59-65.
Dreisinger TE. Strength training and low back pain. Strength Cond J
Frounfelter G. Selected exercises for strengthening the cervical spine in
adolescent rugby participants. Strength Cond J 2008;30:23-28.
Nau E, Hanney WJ & Kolber MJ. Spinal conditioning for athletes with
lumbar spondylolysis and spondylolisthesis. Strength Cond J 2008;30:43-52.
Greendale GA, et al. Yoga for women with hyperkyphosis: results of a pilot
study. Am J Public Health 2002;92:1611-1614.
Greendale GA, et al. Yoga decreases kyphosis in senior women and men with
adult-onset hyperkyphosis: results of a randomized controlled trial. J Am
Geriatr Soc 2009;57:1569-1579.
Jeng CM, et al. Yoga and disc degenerative disease in cervical and lumbar
spine: an MR imaging-based case control study. Eur Spine J 2010 Aug 15
Williams K, et al. Evaluation of the effectiveness and efficacy of Iyengar
yoga therapy on chronic low back pain. Spine (Phila Pa 1976)
Tekur P, et al. Effect of short-term intensive yoga program on pain,
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randomized control study. J Altern Complement Med 2008;14:637-644.

About dkpilates

Pilates Instructor, Yoga Instructor, Personnel trainer and Group Fitness Instructor. Don teaches Contemporary and the Authentic forms of Pilates, in the later 90's, Don began his study of Yoga. His study of Yoga includes the Hatha, Iyengar, Bikram, and Astanga disciplines. His other areas of interest in fitness include Martial Arts, Spin, Boot Camp Training, and Weight Training. Don has extensive training and certifications from AFFA, IDEA, MadDog, B-Fit and Polestar. Don Continues his of Pilates education with Michelle Larson in Santa Fe New Mexico. His personal philosophy related to fitness is to aid students in a personalized balance of strength, stamina and flexibility. He is dedicated to design a program specifically for his students independent of the season of their life to create functional movement and help them reach their fitness goals.
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