More Posture Exercises

 

**"Will cell phones, tablets, and text messaging make us a world of hunchbacks?"

Exercises for Strengthening the Core: see The Off-Balance Workout at WebMD—Activates deep core muscles that support posture. Improves balance to help prevent falls, especially important in reducing the risk of falls in the elderly with osteoporosis.(See the article: "Balance training program is highly effective in improving functional status and reducing the risk of falls in elderly women with osteoporosis: a randomized controlled trial" M. M. Madureira et al.) And a bonus—provides weight bearing exercise to help increase bone density at the hip bones. The first exercise, the one-legged balance with eyes closed is particularly challenging and can be done anywhere as long as there's something to grab onto in case balance is lost. (Another simple weight bearing exercise for increasing hip bone density is stair–climbing. My hip bone density increased a couple years after moving into a 2 story house.)

Exercises for the Back and Shoulder Blade Stability:

Deep Back Extensor Activation and Strengthening (after Johnson's multifidus*exercise no. 1)

Purpose: To strengthen, and be able to locate and understand what activating the deep back extensors feels like.

— Stand (can be done sitting) and place one hand on the abdomen (at the belly button- Rectus Abdominis). Place the other hand on the lower back around waist level and feel for the vertical band of muscle in the groove on either side of the hard knobs of the spinal vertebrae.

— With one hand on the abdomen, squeeze the abdominal muscles and feel them tighten. With the other hand feel the lower-back muscles on either side of the spine also tighten. (Apparently the multifidus co-activates with the rectus abdominis, the "6-pack muscle" in front.)

— Hold for 3 to 5 seconds, relax, and repeat. Tighten muscles as much as possible. Work up to 20 contractions, once a day.

— Eventually learn to tighten the multifidus/deep back extensors all the way up the back and into the neck.

note: My experience has been that with practice it is possible to tighten the multifidus/deep back extensors with minimal tightening of abdominal muscles, and also to tighten them all the way up the back and into the neck (or at least it seems like I can).

*Multifidus—A series of small muscles that fill the groove on both sides of the column of spinous processes (bony extensions of the spinal vertebra that can be felt just under the skin) from the bottom of the lumbar spine to the top of the neck. Each small muscle spans from one to three vertebral joints, and as a whole, the multifidus helps interconnect and stabilize the entire spine.

Back Extension Exercises:

Purpose: To further strengthen the back extensors of the thoracic and/or lumbar spine

Suggested YouTube video: Core Muscle Exercise Workout: Back Extension Exercise or these directions for Back Extension on About.com.

— 1. Lie on the stomach (I place a firm chair cushion under abdomen) with arms at sides.

— 2. Squeeze the upper and mid back muscles, and lift the chest off the floor, keeping the head in line with the neck (look down, not up).

— 3. (this step not for those with hyper-lordosis of lower back) Squeeze the lower back muscles and lift higher. The lift doesn't need to be super high to be effective. A couple inches is fine. Hold 5-10 seconds at first, then gradually lower and relax. Do every other day and gradually work up to holding for more time.

— 4. Additional step: While doing the partial or full lift, slowly move the arms in an arc around to the front into a half "Superman" pose, and hold for 5-10 seconds at first.

Best if done as one of the last exercises in your workout; back extensions set the stage for improved posture the rest of the day.

— Back Extension Exercises and Osteoporosis: Back extension exercises were used in a Mayo Clinic study aimed at preventing osteoporetic fractures. To further strengthen back extensors, weights in a small backpack were added. The results of one study suggested that people with osteoporosis who did only back extension exercises had decreased incidence of vertebral "wedging" and spinal compression fractures even 10 years after, but those who did flexion exercises such as sit-ups or toe-touches had increased incidence of "wedging" and spinal compression fractures. See articles by Senaki, M et al "Postmenopausal Spinal Osteoporosis: Flexion versus Extension Exercises," "Stronger back muscles reduce the incidence of vertebral fracture: a prospective 10 year follow-up of postmenopausal women," and an abstract,"Can strong back extensors prevent vertebral fracture in women with osteoporosis?

Additional Upper Back Extension and Strengthening Exercise:

See the video of the prone "Y", "T", "W" and "L" positions for posture improvement:
Lie stomach down on floor, place arms in one of the positions, have thumbs pointing up, and keeping shoulders pulled down (not up by ears), squeeze the shoulder blades together while lifting arms and chest. Hold a few seconds then lower the chest.
"Y"—With arms in a large "Y" shape, thumbs up and shoulders pulled down, squeeze shoulder blades together while lifting arms and chest off the floor. Hold a few seconds, then lower.
"T"—With arms straight out at 3 and 9 o'clock, thumbs up and shoulders pulled down, squeeze shoulder blades together while lifting arms and chest off the floor. Hold and then lower.
"W"—With elbows tight to the body, thumbs up and hands straight, squeeze shoulders blades together and lift chest off the floor. Hold, then lower.
"L"— With elbows down at sides and forearms at 90 degrees. Imagine squeezing elbows together behind the back. Lift chest off the floor, hold and then lower.
Start with 8 reps, 3 to 4 times a week. Add 2 reps a week up to 12.

See similar exercises with instructions and illustrations in article by McNitt-Gray and Mathiyakom.

Transversus Abdominis* Activation (after Jemmett)

—Learn to do Kegel exercises first. Apparently, the Transversus co-activates with contraction of pelvic floor muscles. (see Kegels for Men, or Kegels for Women). One way to identify/feel the pelvic floor muscles is to try to stop the flow of urine during urination, but this is something not to do very often because of the risk of urinary tract infection.

—Jemmett advises gentle, gradual Kegel contraction then with one hand on the transversus (a horizontal band/corset of muscle between lower edge of ribcage and top of pelvis, seeillustration) to feel for tightening of the muscle. He says it is important to isolate contraction of the transversus, so with the other hand check that the rectus abdominus (the "6-pack" area below breast bone in front) is relaxed.

—Do several short sessions a day.

—Then add Multifidus Activation. Jemmet advises learning multifidus activation with a partner, who would place a finger pad firmly into the groove of multifidus muscle alongside the central knobs of the spinal column and palpate to identify the part of the multifidus that is atrophied (smaller and softer) from back pain. Then one must learn to tighten that area by thinking about drawing it towards the spinal column (like tightening the buttocks).

*Activation and strengthening of the transversus abdominis and multifidus muscles are important parts of the Australian spinal stabilization method. The transversus is a wide horizontal muscle that acts to flatten the abdominal wall. Origin attachments are at the lower six ribs and a thick sheet of fascia/connective tissue that connects to spinal vertebra. Insertion attachments are at the front 3/4 of the iliac crest of pelvis and inguinal ligament. Weakness tends to increase lumbar lordosis.

Thumbs-up, Palms-up, Front Shoulder and Chest Stretch;

1. Hold arms straight out to the side just a little lower than shoulder height, elbows slightly bent, have thumbs up, palms facing front; 2. Squeeze shoulder blades together and rotate shoulders and arms back to stretch the front of the shoulder, hold 10 seconds; and repeat; 
3. Return to starting point in "1." but rotate thumbs to the back so palms face up, and at the same time lift the chest. 4. Squeeze shoulder blades together and pull shoulders and arms back for a front shoulder stretch, hold ten seconds and repeat; 
I do these every morning. It's like welcoming the new day.

Convert Thumbs-up, Palms-up, to an active chest stretch and back strengthening exercise by using a resistance band (Similar to a Bruegger Exercise)

1. Knot a resistance band so there's a loop at each end. Interlace a thick rubber band to get the knots to hold. (To make the loops without a knot, see these instructions)

2. Starting position: Thumbs up, elbows at 90 degrees, palms facing each other, and the loops across the palm.

3. Keep palms vertical or bend the wrists and turn palms up. (illustrations show palms–up, which is closer to the Brueggar Exercise) Pull hands apart by squeezing the shoulder blades together and rotating the shoulders outward.

4.When the band begins to stretch, very slowly continue pulling the arms apart. 

5. Straighten the elbows and slowly pull the arms to the back as far as comfortable. Then hold at least 4 seconds.

Notes: Take at least 8 seconds to pull the arms apart after band tightens, hold 4 seconds and take another 8 seconds to return the arms to starting position. Repeat several times or until muscles become too fatigued to continue. Make the band shorter or advance to a stronger resistance band if 20 repetitions becomes too easy.

Useful Videos:

How to Improve Posture -- powered by ehow

Dr. Kelty Demonstrates Good Sitting Posture:
 

 

see Dr. Kelty's website for more useful videos such as Yard Work without Back Pain

**When using a cell phone for text messaging, anchor your upper arms close to your ribs and bend your elbows to raise the phone closer to your face. Then lower your eyes to see the screen, instead of bringing your face closer to the phone. Iif you still must tilt your head, avoid bending the neck forward and down, instead use the top-most “hinge” joint of the neck. But do try to have your arms and eyes do most of the work.