Wellness & Lifestyles Australia

POSTURAL EXERCISES
& SPINAL HEALTH E-BOOK
prepared by
Wellness & Lifestyles Australia

2007,2008,2009

Table of Contents

Page No.

IMPORTANT NOTICE ..................................................................................................... 2

INTRODUCTION .......................................................................................................... 3
SPINAL ANATOMY ........................................................................................................ 4
IMPACT OF POSTURE ON SPINAL HEALTH ............................................................................ 7
EXERCISES FOR THE NECK ............................................................................................. 10
EXERCISES FOR THE UPPER AND LOWER BACK ..................................................................... 15
SUMMARY ................................................................................................................ 20
RESOURCES .............................................................................................................. 20
CONTACT US ............................................................................................................ 21

MANUAL LAST MODIFIED 18/01/2012

IMPORTANT NOTICE
The information provided in this document can only assist you in the most general way. This document
does not replace any statutory requirements under relevant State and Territory legislation.
Wellness & Lifestyles Australia (W&L) accepts no liability arising from the use of, or reliance on, the
material contained in this document, which is provided on the basis that the Office of W&L is not thereby
engaged in rendering professional advice. Before relying on the material, users should carefully make their
own assessment as to its accuracy, currency, completeness and relevance for their purposes, and should
obtain any appropriate professional advice relevant to their particular circumstances.
To the extent that the material in this document includes views or recommendations of third parties, such
views or recommendations do not necessarily reflect the views of the Office of W&L or indicate its
commitment to a particular course of action.
Copyright Australia 2009
This work is copyright. You may download, display, print and reproduce this material in unaltered form
only (retaining this notice) for your personal, non-commercial use or use within your organisation. Apart
from any use as permitted under the Copyright Act 1968, all other rights are reserved.

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INTRODUCTION
Welcome to the W&L series of e-Books. You have chosen the edition on postural exercises and spinal
health.
This resource will be beneficial to
Anyone who suffers from neck or back problems
Anyone who wants to improve their posture to help prevent back and neck injury
Anyone who would like to keep their spine in a healthy state and maintain a balance across their
joints
The information provided is up to date and follows industry standard. W&L recommend that you continue
to consult your physiotherapist so that your progress can be monitored and program tailored to your
specific requirements.

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SPINAL ANATOMY

Figure 1: Bone anatomy of the spine

Diagram taken from:
Atlantic Spine Specialists, Spine Anatomy, accessed 18 January 2012 on
http://www.atlanticspinespecialists.com/images/anatomy1.gif

Our spine is made up of 33 vertebrae stacked on top of each other. These can be divided into four main
segments, the cervical, thoracic, lumbar and sacral (including coccygeal) regions. The shape of the
vertebrae change slightly between regions to suit the different functions of each area. The cervical region
has 7 relatively small vertebrae which are designed to allow quite a lot of movement flexion, extension,
rotation, lateral flexion). Most of the movement comes from the upper part of the neck. In a normal
cervical spine there is a slight concave curve called a lordosis.
The thoracic region is the 12 vertebrae between the neck and lower back. These are distinct from the
other vertebrae as they also have ribs attaching onto them. The ribs act to limit the amount of possible
movement, allowing only small amounts of rotation & flexion. The thoracic spine has a convex curve
called a kyphosis.
The lumbar vertebrae make up the last 5 vertebrae of the lower back. These are much larger due to the
weight they have to support and mainly allow movements of flexion (bending forward) and extension
(bending backwards) as well as a small degree of rotation. The lumbar spine, like the cervical, has a
concave curve or lordosis. The sacral area consists of 5 vertebrae which are fused together (forming the
sacrum) and fit into the pelvis.

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Figure 2: (a) Spinal cord & nerve anterior view & (b) Superior view
Diagrams taken from:
(a)Spine Universe, accessed 18 January 2012
http://www.spineuniverse.com/sites/default/files/legacy-images/hs2fig5-BB.gif
(b) Atlantic Spine Specialists, Spine Anatomy, accessed 18 January 2012 on
http://www.atlanticspinespecialists.com/images/anatomy1.gif

As the vertebrae stack on top of each other to form the spine, a canal is formed where the spinal cord
extends from the brain. Between each pair of vertebrae are foramina where nerve roots project from the
spinal, exit the spine and travel to all parts of the body. At each level, a nerve root exits on the left and
right side.
Figure 3

Figure 3: Anatomy of an intervertebral disc

Diagrams taken from:
Dr. Barrie Lewis, Chiropractic-Help, accessed 18 January 2012
http://www.chiropractic-help.com/images/IntervertebralDisc.jpg

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Situated between each vertebra (for the majority) is a sponge like disc. The disc helps to absorb force and
assist movement in the spine. The disc itself is comprised of 2 layers the fibrous annulus fibrosis and the
gel like nucleus pulposus (see fig 3). Surrounding the spine to provide support to the bony structures and
produce movement are many ligaments and muscles (see figure 4 and 5).

Figure 4: Example of spinal ligaments

Diagram taken from:
GiyabRadiology, accessed 18 January 2012
http://giyabradiology.blogspot.com/2011/05/spinal-column-anatomy-images.html

Figure 5: Musculature, deep and superficial, of the back

Diagram taken from:
Build Muscle Abs, Get Off Balance! Instability Exercises Work Your Core, accessed 18 January 2012
http://www.musclebuildingrevolution.info/get-off-balance-instablity-exercises-work-your-core/

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IMPACT OF POSTURE ON SPINAL HEALTH

As there are many structures that make up the spine, it is important to ensure that there is a balance in
strength and movement between different levels and sides of the spine. This balance is best maintained
when the spine is in a neutral posture - the position in which it works most effectively and where
structures are under the least amount of strain. If the spine is not held in its neutral position, for example
it is bent forward, bent backward or twisted, for prolonged periods of time, there are potential
consequences. Not only is extra strain placed on the ligaments, joints, nerves and discs, both adjoining
and within the spine, but the muscles surrounding the spine also have to work harder to provide support.
A waterfall effect can result, with increased strain placed on peripheral joints, such as the shoulders,
hips, knees and ankles, in addition to the strain on the central structures.
A reverse process can also occur. Examples of this include over pronation at the ankles, leg length
discrepancies and valgus (knock-kneed) or varus (bow legged) deformities of the knee. These changes in
stress and loading at the peripheral joints can then cause discomfort, pain and altered stresses in the
spine. Footwear can exacerbate these issues if shoes are in poor repair and provide poor support. High
heeled shoes can also cause a change in the centre of gravity, which often presents as loading of the low
back muscles with increased lordosis, again leading to pain and discomfort, especially if core stability and
posture are also impaired.
Common sagittal plane postural changes can be seen below (fig 6) showing kyphosis and lordosis
alterations. Figure 7 demonstrates curvature in the coronal plane, known as scoliosis. Other changes in
the spine such as spondylolisthesis or spondylolysis (a slip of one vertebra on another +/or fracture of the
pars interarticularis), spondylosis (general degenerative changes within spinal joints) or spinal canal
stenosis (narrowing of the spinal canal) can also cause the imbalances previously described.
Additionally there are a number of postural changes specifically related to the aging process, including
decreases in disc height, decreases in vertebral height (including due to wedge or crush fractures), and an
overall decrease in soft tissue extensibility.

Figure 6: 4 types of postural alignment

Diagram taken from:
Pilates Works 4 Life, Gotta Hunch? Part 4, accessed 18 January 2012
http://www.pilatesworks4life.blogspot.com/2008_04_01_archive.html

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Figure 7: Examples of scoliosis curvatures

Diagram taken from:
National Institute of Arthritis and Musculoskeletal and Skin Diseases, Q&A about Scoliosis in Children and Adolescents,
accessed 18 January 2012
http://www.niams.nih.gov/Health_Info/Scoliosis/default.asp

In the short term, muscle imbalances from altered posture can result in pain and discomfort through local
spasm, strain or fatigue. In the long term, these resultant stresses can combine to cause permanent soft
tissue damage and pain, as well as decreased performance of the joints and soft tissues. Other permanent
changes include joint degeneration (osteoarthritis with pain, stiffness and decreased joint range of
movement), disc damage (bulge, prolapsed including nerve and muscle symptoms), muscle shortening or
rupture and local nerve impingements/entrapments.
To help prevent these consequences, poor posture can be improved by completing strengthening and
stretching exercises which will increase muscular support and improve balance to the spine.

How do you know if you have a muscle imbalance, joint stiffness or disc injury?
The most common way in which people become aware of these issues is the development of pain. A
physiotherapist can check for appropriate neutral positioning of muscles and joints to ensure there are no
muscle imbalances - whether in power, lengthening or shortening of muscle groups. Joint stiffness is noted
through individual awareness and again your therapist can check for decreased range of movement,
localised joint or segmental stiffness. Conversely, your therapist can also assess whether a client exhibits
range over and above the usual. This increase in movement can in turn cause pain by overuse of the joint
and decreased stability.
Acute back injuries can include muscle, joint, nerve (including spinal cord) or disc injuries. They may
present as pain, swelling, altered movement/lack of movement, muscle weakness or numbness, depending
on the pathology. In these cases it is important to see a medical practitioner and/or physiotherapist to
determine the best management options.
As a general rule, muscle and soft tissue pains present as an ache or stiffness, muscle spasm may result
in a stabbing presentation of pain.
Nerve issues are often characterised by unusual sensations such as burning or pins and needles. Sharp
pains can often also occur with nerve injuries. Physical signs include weakness, altered or decreased
sensation to pressure or temperature, depressed reflexes.

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Addressing the problem

The most common way to address these problems is through a stretching and strengthening program. Short
muscles are stretched; weak muscles, whether short or long can then be strengthened.
Any client with a back injury is also likely to have altered core stability (figure 8). This refers to the back
extensors (multifidus and erector spinae), the low stomach muscles (transversus abdominus), the
diaphragm of the lungs and the pelvic floor. The transversus abdominus especially are effected in the long
term after a back injury and commonly require targeted retraining. Usually the use of the transversus
abdominus is an unconscious action and this may cause active retraining to be more difficult. In difficult
cases, real time ultra sound (RTUS) can be employed to provide the client with an increased level of
feedback.

Diaphragm
Multifidus &
Erector spinae
Transversus
abdominus
Sacrum

Pelvic floor

Pubic symphysis

Figure 8: Muscles and structures making up the bodys core

Diagram taken from:
Physio Works, What is your core stability?, accessed 18 January 2012
http://www.physioworks.com.au/treatments-1/core-stability-exercises

In rare cases neck or back supports or braces can be used to help provide support. Usually these are used
in acute instances and at medical request. Prolonged use of bracing can actually cause a worsening in the
pathology due to muscle wasting (the brace does the work, not the muscles) and thus further undermine
joint support.

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EXERCISES FOR THE NECK

The following exercises should be performed with caution to pain and in consultation with a therapist if
you have concern with any of these exercises.
Stretching: upper trapezius To stretch the left side, bring your right ear to your right shoulder then turn
your head to the left (looking upward). Look down towards your left armpit and reach your left hand
towards the ground/behind your back. Hold for 30 seconds and repeat 3 times. Repeat to stretch the right
side.

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Stretching: levator scapula To stretch the left side, bring your right ear to your right shoulder and then
turn your head to the right. Look down towards your right armpit and reach your left hand towards the
ground/behind your back. Hold for 30 seconds and repeat 3 times. Repeat to stretch the right side.

Stretching: side tilting To stretch the left side, bring your right ear to your right shoulder, assist using
your right hand. Hold for 30 seconds and repeat 3 times. Repeat to stretch the right side.

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Stretching: turning Turn to the left, using your left hand to gently push your right cheek. Hold for 30
seconds and repeat 3 times. Repeat to turn to the right side.

Stretching: forward nodding Have both hands behind your head. Tuck your chin in and look down
towards your chest and use your hands to help gently. Hold for 30 seconds and repeat 3 times.
Stretching: upper aspect of the neck To stretch the left side, place your left hand on your chin and
right hand on top of your head. Use your left hand to push in your chin and then use your right hand to
pull your head forward and slightly off to the right. Hold for 30 seconds and repeat 3 times. Repeat to
stretch the right side.

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Strengthening: Head retraction Poke your chin forwards and curl your neck. Work the muscles which
pull your head back on top of your neck and tuck your chin in. Pull your shoulders away from your ears.
Hold for 5 seconds and repeat 10 times.

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Strengthening: Head retraction lying down Lie on a pillow and tuck in your chin. Keep your chin tucked
and squash the pillow with your head. Hold for 5 seconds and repeat 10 times.

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EXERCISES FOR THE UPPER AND LOWER BACK

Strengthening: Retraction of scapulae - Whilst maintaining your neck and back in a neutral posture,
concentrate on drawing your shoulder blades backward and together. Hold for 10 seconds and repeat 10
times. Ensure you feel the contraction relax between repetitions. If you can not, try holding for a lesser
period of time until you can feel yourself relaxing at the end of the contraction. Avoid actively moving
your arms when doing this exercise.
Strengthening: Depression of scapulae - Whilst maintaining your neck and back in a neutral posture,
concentrate on drawing your shoulder blades downward and together. Hold for 10 seconds and repeat 10
times. Ensure you feel the contraction relax between repetitions. If you can not, try holding for a lesser
period of time until you can feel yourself relaxing at the end of the contraction. Avoid actively moving
your arms when doing this exercise.
Stretching: Upper back stretch Reach arms above head and hold hands. Squeeze your shoulder blades
down and back. Use your abdominal (stomach) muscles to prevent your lower back arching. Hold 20
seconds and repeat 5 times.

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Stretching: Back rotations sitting Sit on the floor with your right leg crossed over your left. Turn to the
right and push on your right knee to increase your stretch. Hold 20 seconds and repeat 5 times. Repeat in
the opposite direction.

Stretching: Back twists lying Lie on the floor with arms out to the side and knees bent up. Cross your
right leg over your left and let your knees drop over to the left side. Reach your right arm out away from
your body to increase the stretch. Hold 1 minute and repeat going the opposite direction.

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Stretching: Prayer stretch Position yourself on all fours and then sit back onto your heels. Reach your
arms out in front and hold for 30 seconds. Crawl your hands over to the right side to stretch out your left
side and hold for another 30 seconds. Crawl your hands over to the left side to stretch the opposite
direction.

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Back extensions Prop on your forearms whilst lying on your stomach to maintain the extended position
in your low back. Hold the position for 30 seconds, rest and repeat 3 times.
Back curls Lie on your back and curl your knees to your chest. Relax in this position for 20 seconds. Draw
small circles with your knees 10 times and repeat in the opposite direction.

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Strengthening: Transversus abdominus - Whilst lying on your side, draw your belly button in toward your
spine. Hold it for a count of 10. Make sure you can feel it relax at the end of the contraction. If not try to
maintain your hold for a smaller length of time until you are able to feel the contraction relax. Do not
hold your breath if you are, you are not activating the correct muscles.
To progress this exercise, undertake the exercise in sitting, standing and whilst moving. Aim to complete 2
sets of 10 repetitions, each with a 10 second hold.
Strengthening: Pelvic Floor - The pelvic floor is made up of a sling of muscles stretching from the pubis
and pubic rami anteriorly to the coccyx posteriorly in gross terms. As such it controls both urethral and
anal outlets. Strengthening is by drawing the pelvic floor up recreating the feeling of hanging on to
get to the toilet or stopping yourself passing wind. These exercises can be undertaken for both strength
and endurance.
Strength: repeat the drawing up feeling 20 times quickly
Endurance: repeat the drawing up feeling 10 times, for 2 sets, holding each one for 10 secs (ensure you
feel the muscle relax at the end of each contraction).

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SUMMARY
In summary, the spine is a complex structure made up of many components which work together to allow
the spine to move efficiently. Through bad posture or injury the spine can be strained and structures
become unbalanced. By doing exercises which strengthen and stretch the various components of the
spine, support can be increased to improve spinal health.
Please use this resource as a guide to your exercises in consultation with your therapist.
All the best for a strong and healthy spine,
The W&L Team

RESOURCES

Sports Med booklets on postural exercises for neck and upper back, and neck exercises were
referred to for the content of this e-book.

Better Medicine, Rich Klasco, M.D., FACEP (2011), Spondylolsis,

http://www.bettermedicine.com/article/spondylosis

American Academy of Orthopaedic Surgeons, Pediatric Orthopaedic Society of North America

(2007), Spondylolysis and Spondylolisthesis, http://orthoinfo.aaos.org/topic.cfm?topic=a00053

Spine Universe, Stewart G. Eldelson, MD (2010), Spondylolisthesis,

http://www.spineuniverse.com/conditions/spondylolisthesis/spondylolisthesis-0

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CONTACT US
Wellness & Lifestyles Australia
2/59 Fullarton Road, Kent Town SA 5067
P: +61 8 8331 3000
F: +61 8 8331 3002
E: contact@wellnesslifestyles.com.au
W: www.wellnesslifestyles.com.au www.wleducation.com.au
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