Injuries involving the spine are very common and these can lead to a wide variety of symptoms, from mild pain to paralysis and even death. The spine can be viewed as the wiring harness of the body. It carries and protects the spinal cord and enables the brain to communicate with and control the whole body. Serious damage to the vertebrae can lead to impingement of the spinal cord, pain or loss of any feeling (e.g. in the hands, arms, chest) and in the worst case total loss of control in certain parts of the body.
Like a wiring harness in a car, the spinal cord branches out into adjacent parts of the body as one moves down from the neck to the end of the spine (coccyx). This means that the location of a spinal injury (i.e. which vertebrae are damaged) can be determined by identifying which part of the body is exhibiting injury symptoms.
The vertebrae are divided into 5 main groups:
1. Cervical spine (top 7 vertebrae forming the neck)
2. Dorsal spine (next 12 vertebrae forming the upper back)
3. Lumbar spine (next 5 vertebrae forming the lower back)
4. Sacrum (bottom 5 fused vertebrae between the buttocks)
5. Coccyx (the 3 to 4 fused vertebrae at the end of the spine)
When you visit an injury specialist they will explain to you which vertebrae are injured by using a simple code system. For example, C3 is the third cervical vertebrae from the base of the skull.
Most of the vertebrae are separated by an intervertebral disc and articular cartilage that allows a certain range of motion of the spine. Each disc contains a gel like substance to provide cushioning, lubrication and energy absorption. Anterior (front) and posterior (rear) longitudinal ligaments connect the vertebrae. In addition, various other ligaments manage how the spine is loaded and integrated into the various muscle groups during lifting. For example, in the cervical region (ligamentum nuchae) and from C2/C3 to L5/S1 (ligamenta flava).
Some of the injuries that can occur to the spine include:
1. Vertebrae fractures can be especially dangerous because the spinal cord passes through the vertebrae and displacement of the vertebrae walls can put pressure on this very delicate structure. Cervical fractures in particular need immediate medical attention and neck immobilisation to avoid serious injuries (e.g. paralysis) and long term problems (e.g. Osteoporosis). The most common fractures occur in the lumbar (e.g. L5) and these cause pain spreading across the lower back, back stiffening and tight hamstring muscles (that often cause muscle imbalances and posture changes).
2. Vertebrae abnormalities such as bone spurs (bony projections that form along joints) can cause pain and limit joint motion. Some of the symptoms include neck, shoulder and arm pain, loss of balance and even headaches radiating to the back of the head.
3. Spinal cord and surrounding nerve root damage can occur in whiplash injuries (e.g. due to a car accident) or nerve stretch injuries (e.g. due to a rugby tackle from behind that causes the neck to be bent backwards). A pinched nerve refers to a condition in which one of the cervical disks is putting pressure on one of the spinal nerves connected to the spinal cord. There are a very wide range of symptoms from numbness, tingling and burning feelings in the skin to muscle weakness, pains and stiffening in the neck and arms to ear ringing, blurred vision and even irritability.
4. Disc injuries. The term slipped disc (also known as a herniated, ruptured or prolapsed disc) is used when a disc becomes split and the gel like filling leaks out to cause pressure on the spinal cord or surrounding nerves. These injuries normally occur in the lower back. Symptoms may include neck and back pain, tingling in the buttocks, back, legs or feet and even incontinence.
5. Thoracic muscle strains. The spine can not be considered in isolation to the groups of muscles that support the whole upper body. These muscles can be divided into three main groups; the extensors (back muscles and the buttock muscles), the flexors (front of the body muscles such as the abdominals) and the obliques or rotators (the side muscles). They work together to protect and support the spine. However, if for example, a certain back muscle is strained during lifting this protection is compromised. The body reacts with muscle contractions that cause a stiff back and a more limited range of motion.
6. Spinal ligament sprains. In general, the strong but relatively inflexible ligaments will take longer to recover than muscles because of their poorer blood circulation. This means that more care should be taken in ligament rehabilitation with a longer period of rest and flexibility rather than strengthening exercises.
The key objectives of an injury workout routine are to regain the range of motion, flexibility and strength of the spine and surrounding ligaments and muscles. The first objective is to regain the flexibility, stability and range of motion of the spine and this article describes injury workout routines to do this. This will enable muscles to relax, injured tissues to regrow in the correct manner and a person to restore a normal life faster (e.g. with no pain). These routines should always be followed up by whole body workout routines to restore muscle strength and balance in the whole body, for example to restore correct posture (one of the main factors that can contribute to spinal injuries).
Daily stretches can be used to slowly increase the flexibility of the spine and these should be followed by gentle strengthening exercises so that the body is ready to move onto whole body exercises. The following is a list of injury workout routines for stretching and strengthening the cervical spine, dorsal spine and lumbar spine. Hold a stretching position for as long as feels comfortable and repeat a strengthening exercise for as many times as you are able to (aim for 5 to 10 repetitions and hold each repetition for a few seconds initially).
Cervical spine (neck) stretching exercises:
1. Supine spine relaxation and lengthening. Lie on your back next to a wall so that your feet are resting on the wall, your lower legs are horizontal and your knees are bent at 90 degrees. Start with your spine in a natural curved shape (your hand should be able to just pass under your lower back). Slowly relax your spine into the floor and lengthen it by imagining a piece of string pulling the top of your head, so that your spine is straightened out. A warm blanket, water bottle or electric blanket under your back will help you to relax the muscles. All you need to do is relax and listen to the TV or music for as long as you like!
2. Sitting posture correction. Sit on a bench next to a wall. Begin by sitting upright in good posture with your shoulder blades pulled together and downwards. As with the first exercise imagine a piece of string gently pulling the top of your head upwards so that you lengthen your spine upwards. In the beginning you can sit against the wall to check how upright your posture is. However, try to hold this position away from the wall once you get a better feeling for the correct posture. Every day try to increase how long you can sit like this.
3. Once you are able to hold a good sitting posture you can move on to some neck flexibility exercises. The first is simply rotating your head forwards (remember to imagine the spine lengthening) until your chin touches your chest and then rotating it upwards as far as you feel comfortable.
4. Taking turns on each side of your body and facing forwards, bend your neck sideways towards each shoulder blade (remember to keep your good sitting posture throughout!).
5. Roll your head forwards (only) from one shoulder to the other with your chin remaining in contact with your chest.
6. Roll your head all the way around (as in the previous exercise but roll your head behind you as well) in a smooth gentle motion.
Cervical spine (neck) strengthening exercises:
1. Sitting with good posture place a palm on each side of your neck with your thumbs under the back of your jaw and your elbows raised sideways above your shoulders. Tense you muscles on the back of your neck downwards against your fingers (that are resting on the base of your skull).
2. Again sitting with good posture move your elbows forwards and upwards. Place your palms on each side of your forehead. Gently press your forehead against your palms so that the front of your neck becomes tense.
3. In the sitting position raise one elbow sideways above your shoulder and place your palm on the side of your forehead. Gently press the side of your forehead against your palm so that the side of your neck becomes tense. Repeat on the other side of your body.
4. A partial diagonal crunch. Lying on your back on a soft mat with your knees together and bent at 90 degrees place your fingertips on your ears and allow your elbows to rest on the floor (at the same level as your shoulders). Raise one elbow whilst keeping your fingertips (only) in contact with your ear and your neck in line with the rest of your spine (i.e. try not to poke your neck forward). The main idea is to force the neck to carry the weight of your head rather than concentrate on working the abdominal muscles.
5. The plank position enables you to strengthen all the muscles that support the spine. Begin by lying face down on the floor and then place your elbows directly under your shoulders whilst making your upper arms vertical and placing your forearms forwards so that your hands are clasped together. You should only have your toes, elbows, forearms and hands touching the floor. Make sure that your whole spine is in its normal curved position and your body is effectively straight without the bottom sagging down or unnaturally pushed upwards. It is important to keep your abdominals and core tightly engaged.
6. Standing press ups against a wall with your hands wide apart, your feet together and your shoulder blades pulled together and down will help to start rebuilding the strength of the neck and shoulders.
Dorsal spine (upper back) stretching exercises:
1. Supine spine relaxation and lengthening. See the cervical stretching exercises description for the details.
2. Sitting posture correction. See the cervical stretching exercises description for the details.
3. Standing upright place the palms of your hands behind the neck and smoothly rotate the upper body first to the left and then to the right. Concentrate on rotating your head, neck and shoulders as one. This means that you begin facing forwards and your face ends up looking to the left or the right.
4. Again standing in good posture and facing forwards with your palms touching your hips, bend your body sideways by first sliding one hand down your thigh and then the other hand. Remember to keep your body in a vertical plane (don't lean forwards or backwards when bending).
5. In a sitting position hold a rod behind your back between both of your hands (with your elbows pointing downwards). Use the rod to pull your shoulder blades down and together so that you form a valley between your shoulder blades.
6. Kneeling on the floor on all fours with your arms straight and vertical rotate your pelvis forwards so that your back arches up. Hold this position for a few seconds and slowly lower back down to a normal spine position (i.e. do not arch your back down).
Dorsal spine (upper back) strengthening exercises:
1. Hip lift. Lying on your back with your knees bent at 90 degrees, feet shoulder width apart and your arms folded across the abdomen raise your hips upwards as far as is comfortable and then gently lower.
2. Partial crunch. Lying on your back with your knees bent at 90 degrees, feet shoulder width apart and your arms folded across the abdomen raise your chest upwards as far as is comfortable and then gently lower. Try to keep your neck in line with the rest of your spine and not to poke your neck forward.
3. Partial back extension. Lying face down with your hands resting on your buttocks gently try to raise your chest upwards a small distance. As with the other exercises keep your spine in line with your neck and rotate from the hips. The aim is to tense the back muscles and not to lift the body high off the floor.
4. A partial diagonal crunch. For full details see the cervical spine strengthening exercises.
5. The plank position. For full details see the cervical spine strengthening exercises.
6. Standing press ups against a wall. For full details see the cervical spine strengthening exercises.
Lumbar spine stretching exercises:
1. Supine spine relaxation and lengthening. See the cervical stretching exercises description for the details.
2. Sitting posture correction. See the cervical stretching exercises description for the details.
3. Lying on your back with your knees together and bent at 90 degrees, first move them to one side on the floor and then the other. Keep the whole upper back in contact with the floor so that your face does not move.
4. Lying on your back (on a soft mat) with your knees together curl up into a ball with your arms wrapped around your shins and pull your legs to your chest. You can also rock to and fro slightly when fully curled up.
5. Lying on your back with your knees together and bent at 90 degrees, begin by sliding one hand under your lower back to check the curvature of your spine. Hold this spine curvature as your starting point and then close the gap by rotating your hips forward. As with many of the exercises imagine your spine being lengthened and straightened not shortened and compressed.
Lumbar spine strengthening exercises:
1. Lie on your back with both legs straight and your hands by your sides. One at a time rotate each bent leg towards your chest as far as is comfortable. Keep your buttocks in contact with the floor at all times and the hips remain horizontal (i.e. do not lift one side).
2. The same as the first exercise but rotate both legs at the same time with the knees together.
3. Lie on your back with your hands by your sides, both legs straight, knees together and your feet resting on a small box about 20 cm high. Rotate both straightened legs upwards and then slowly downwards down on to the box again.
4. The same as the second exercise except that when both legs are fully raised move them as if you were cycling.
5. A partial crunch. See the second dorsal spine strengthening exercise for full details.
6. A partial diagonal crunch with opposite knee lift. Lying on your back on a soft mat with your knees together and bent at 90 degrees place your fingertips on your ears and allow your elbows to rest on the floor (at the same level as your shoulders). Raise one elbow whilst keeping your fingertips (only) in contact with your ear and your neck in line with the rest of your spine (i.e. try not to poke your neck forward). As you raise your elbow lift the opposite knee upwards at the same time.
In summary, spinal injuries are relatively common and you should always consult an injury specialist to fully understand the nature of your injury and undergo some initial treatment. However, this is not the end of the story if you want a full recovery. You need to follow up any medical treatment with injury workout routines that focus on the spine and then workout routines for the whole body. This article has focused on appropriate stretching and strengthening routines for the three main parts of the spine; the neck, upper back and lower back.
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