THE BACKBONE OF MOVEMENT: SPINAL HEALTH
Published in the Oklahoma Sports & Fitness Magazine. Nov, 2017.
Before moving to Tulsa, I believed that most people viewed Autumn as an unhealthy time of year. Traditionally it’s when heavier clothes are unfolded from boxes, comfort foods make a comeback and the nostalgia of holiday meals are right around the corner. Then after spending a few months treating Tulsa’s most athletic population, I found that autumn is a favorite season for health and fitness! Some of the year’s biggest races take place in the next few months and everyone from the elite athletes to their number one fans are gearing up for this season of athletic celebration. Cyclists are out taking advantage of the fall air, couples are enjoying walks on their lunch breaks and the runners are ready to prove how hard they’ve trained all summer in the Tulsa heat. Because this active group needs a recovery team to help maintain the strenuous training, they often find themselves inside a chiropractor’s office for relief. I know this because I am one of Tulsa’s newest sports chiropractors and although I treat lower leg issues every day, truly fixing an athletic injury almost always comes back to the spine. The spine is an amazing portal of information to locate joint or motor control issues in distant joints so how is it that the most fundamental structure in our body is often overlooked when treating athletic injuries? Chiropractors spend years studying the importance of the spine and its lead role in all that we do because without it, no athletic movements would be possible.
Mobility
The structure of the spine facilitates all mechanical, athletic motion. The simplest way to break down spinal movement during your sport is to visualize four different directions of mobility. Forward bending of the spine is known as flexion, back bending is called extension, side to side bending is lateral flexion, and turning from side to side is an example of the term rotation.The regions of the spinal column can be broken up into four sections and each region caters to those four directions in different levels of excess depending on the anatomy of that specific region. For example, a properly moving cervical spine allows the head a wide array of motion to improve the range that our eyes can see which is perfect for alerting the brain about changes in terrain or the upcoming finish line of a race. A dynamic thoracic spine provides lots of rotation which is useful for golf swings and balancing against the rotation of the pelvis during walking or running (1). The lumbar spine is built for large amounts of sagittal plane movements which consists of straight forward or backward bending. This is ideal for same-direction sports like distance running or cycling. Combinations of side bending and rotation of the lumbar spine enables more complex patterns such as a soccer kick or a twisting yoga pose. The combinations of spinal motion for athletic movements is an endless discussion that continues to inspire and challenge the world’s best joint mechanics and manual therapists. The take-home message is this; no motion in your body can be independent of spinal influence or support.
Assessment
Chiropractors are known for treating the joints of the spine but the field has evolved into a wide array of services besides spinal adjusting such as soft tissue therapy, rehabilitative exercises, and nutritional counseling. If you’re new to chiropractic let me fill you in on how we find the areas of the spine that need to be adjusted. A portion of chiropractors utilize x-ray radiography for a visual assessment of spinal curves, anatomy, and degenerative levels of the patient.
Without film, other doctors depend on a visual assessment of motion reinforced by the information provided from hands-on joint testing known as palpation. Every office will be slightly different in the examination process but we are all trained to compare the quality of movement between each vertebra to decide if it needs more motion or should be stabilized using other techniques. If joint motion is needed, a quick and strategic thrust is induced into the direction of motion that was lost but if our hands find too much motion in a joint of the spine, the stabilizing soft tissue around that region needs to be rehabilitated and no adjustment should be provided.
Activation
One way to stabilize a hypermobile segment in the spine is to improve the neurological activation of the muscles surrounding it. Let’s build from the inside out on that concept; The axial portion of the skeletal system is made up of the skull, spinal column, ribs, and sternum. The word axial comes from axis, which in the body’s case is a central line of reference that our anatomy rotates and revolves around. In the simplest of terms, it’s kind of a big deal. The axial skeleton is the structural home of the power cord of your body, the central nervous system. Lightning fast electricity travels up and down the spinal cord to carry out the bidding of the brain. Because the spinal cord is safely situated inside the tunnel created by the bones of the spinal column, the success of neurological transmission depends on the spine (2). Deviations in joint mobility can alter or influence the information that the brain tries to send to a distant part of the body. Excluding serious trauma or genetic malformations, the deviations in transmission are not from a bone “pinching” the cord and “blocking” some flow of electricity. A more accurate description of the impedance uses receptors to explain the conversation between nervous system and bones.
Every joint in the body is lined with receptors, a meeting point between the nerves and the structure that they control. That’s how the brain can perceive where in space our body parts are, what activity they are doing, and what materials they need to be successful. For example, while running your feet are constantly adapting to the ground around you by sending messages to your brain about what’s happening down there. When motion is lost inside a joint, your brain can no longer send or receive information from that joint due to receptor interference.
The St. Louis Cardinal’s chiropractor Dr. Brett Winchester, describes this phenomenon as “Bad information in is bad information out.” Over time this disconnect with parts of your own body leads to muscle atrophy, poor balance and injuries. A chiropractic adjustment improves the communication between the joints and the brain along with the surrounding muscles in control of that joint. By restoring motion and balance, the nervous system can reach the function it was designed for because the movement receptors are working properly and the pain receptors at each joint are diminished.
Take A Deep Breath
It’s no new information that chiropractic care helps to improve posture and spinal range of motion, so I make an extra effort to educate patients about the relevance of those improvements to their sport. One of the most powerful features of a properly moving spine is breathing restoration. Breathing is the key link to unlocking optimal neurology, it serves as the “control-alt-delete button” to reset stress, tight muscles, and poor posture. When restrictions between the spine and the ribs are released, the breathing apparatus can fully expand and provide your body with more fuel to perform. The increase in neurological awareness that follows a spinal manipulation will allow the lungs and diaphragm to sync together and match the rhythm of breathing during your sport. The diaphragm can then become a respiratory muscle and a stabilizing muscle. The dual role of the diaphragm is essential for spinal stability and all resulting movements, especially for the complex tasks that comprise athletic performance (3). What does more air and improved efficiency of oxygen exchange mean for your athletic endeavors? Go longer and go faster!
Preservation
Children start learning to play sports at a very young age now which is causing an influx of talented teenagers and collegiate athletes. This growing population is looking for new strategies to gain a competitive edge and I believe that chiropractic care is an important role for their success. Younger patients want to develop safely as they play sports while older patients want to maintain their activities as long as possible. Chiropractors offer athletes a diverse and conservative approach that will ensure a more rewarding participation at any stage in life. Although chiropractic adjustments cannot remove the years of microtraumas that an active lifestyle creates, they can slow the degenerative effects of training and intense competition. Restored function of the spine allows the foundational structures to withstand and safely distribute the stress created by athletic participation. For example, a properly functioning sacrum (tailbone) is an amazing shock absorber which tries to diminish forces at the pelvis before it reaches the spine (1). When a joint is moving properly the involved muscles and tendons can withstand the stresses that they were built to accommodate. So how do you get this balanced spine and keep it? We call it tensegrity. Tensegrity is an architectural system in which structures stabilize themselves by balancing the counteracting forces of compression and tension between muscles, bones, and tendons (4). When the body is out of alignment and loses its tensegrity, unbalanced forces pull on the soft-tissue and send uneven stresses to the spine. Joint restoration will minimize the prevalence of soft tissue injuries and bone deformity caused by the shearing of muscular imbalances.
““It explains why a runner landing on the calcaneus (heel) does not fracture the bone because tension is transmitted throughout the structure. It also explains why only paying attention to the skeletal anatomy limits a practioner’s ability to provide a dynamic solution for patients.” ”
Spinal Care At Home
There are a lot of healthy changes you can make at home to maintain your tensegrity. It surprises patients to learn that things beside movement and body positions can trigger spinal dysfunctional. Lifestyle factors such as stress, emotional imbalances, dietary choices and hydration levels can alter the chemical health of the muscles and ligaments that support your spine. For any back pain, I recommend eating an anti-inflammatory diet until the pain calms down (if you can’t commit to long term dietary change). This type of nutritional intake consists of mostly meats, healthy fats, and vegetables which excludes processed sugars, starchy grains and most dairy products. A wonderful resource to learn more about this style of eating is The DeFlame Diet but Dr. David R. Seaman. Once inflammation is controlled, the most valuable way to preserve the spine is to stay moving. In our sedentary society, prolonged sitting is the most prevalent and irreversible stressor to the spine. A lifetime of hours spent sitting at a desk will alter forces placed on the spine and can permanently change muscle fibers from being in the prolonged, flexed position. This unavoidable position is encouraging several of our patients to request stand-up desks from their employers. Ergonomically safe work stations in addition to chiropractic maintenance is a wonderful way to prevent the routine of your work day from hindering your athletic activities outside of the office.
Specialty
Chiropractic care works well with athletic individuals because of the body awareness and visualization skills they acquire through their activity. These skills help athletes respond to manual intervention fast because movement is used for more than just an assessment, it’s also the treatment! Because muscular and ligamentous injuries heal better when movement is incorporated into the recovery period, chiropractic adjustments and soft tissue therapies are designed to mimic your sport and the mechanism of injury (4). Most of the issues that chiropractors treat are related to spinal restrictions but sometimes, adjusting that restriction is only resolving a secondary or compensatory issue and not the real causes of pain. If the spine is truly the primary problem, then most people only need the occasional manipulation for tune ups. If they go to a chiropractor regularly just to feel normal than they are lacking tensegrity and cannot prevent a relapse in symptoms. So, the endless cycle of pain and chiropractic visits will continue.
Movement Medicine
Chiropractors strive to reduce pain but the job isn't complete until we correctly assign and prevent faulty movements that led to the injury. I truly believe that our bodies are designed to be active and dynamic beings so with proper technique and recovery efforts, any movement such as running, cycling or walking should not hurt! With this revelation in mind, your chiropractor should be your foundation for musculoskeletal health. Then with a perfect balance between a properly moving spine and safely stabilized support system, your performance and athletic opportunities are endless.
References
Michaud, Thomas C. Human Locomotion: The Conservative Management of Gait-Related Disorders. Newton, Massachusets. Newton Biomechanis. 2011. Print 104.
McGill, Stuart. Low Back Disorders. Champaign, IL. Human Kinetics. 2007. Print 36.
Clinical Commentary Dynamic Neuromuscular stabilization & Stabilization & Sports Rehabilitation. Clare Frank, DPT, OCS, FAAOMPT1 Alena Kobesova, MD, PhD2 Pavel Kolar, PT, PhD2. Online.
Hammer, Warren. Functional Soft-Tissue Examination and Treatment by Manual Methods. 3rd Edition. Sudbury, MA. Jones and Bartlett Publishers Inc. 2007. Print 209.
Fig-1: The axial skeleton. Adapted from https://courses.lumenlearning.com/boundless-biology/chapter/types-of-skeletal-systems/
Fig-2: Regions of the spine. Adapted from Development of Application Ontology of Lenke’s classification of Scoliosis. 10.1109/BIBE.2015.7367732. Nov 2015. http://www.researchgate.net. Online.
Fig- 3: Spinal motion of flexion and extension. Graphic adapted from Physiology of the Joints, Vol. 3: The Vertebral Column, Pelvic Girdle and Head,6th Edition. A.I. Kapandji, page 39, copyright 2008. Print.
Fig- 4: Planes of Motion. http:www.anatomy.tv/studyguides/images/planes.jpg
Stock Photos- Purchased from istockphoto.com.