Anatomy Lesson: The Spine

Next stop in our anatomy lessons in the ever important spine.  Check out the previous editions - Foot/Ankle, Knee, Hip/Pelvis

We all know how important our spine is for our overall function, movement, and health.  It's the chassis the makes our upright gait unique and what separates us from all other animals.  Spine health is extremely important and most of us will experience some sort of spinal pain at some point of our lives, and those of us that have experienced it will tell how debilitating it can be.  While everybody knows just how important the spine is and the role is plays, most do not know the basic anatomy and specific functions it plays, so let's take a deeper look 

The spine can be broken down into 4 main sections

• Lumbar Spine - The lumbar spine is the lowest part of the spine and consists of 5 vertebrae.  The lumbar vertebrae are the biggest and thickest vertebrae due to the fact that they bear the most amount of weight.  The lumbar spine are numbered top-to-bottom L1-L5 and naturally form lordosis or an inward curvature.

• Thoracic Spine - The thoracic spine is the middle portion of the spine and consists of 12 vertebrae.  The thoracic spine is numbered top-to-bottom T1-T12, with each progressing vertebrae, moving up the spine, getting a little smaller and thinner than the previous.  The thoracic spine naturally forms kyphosis or an outward curvature.

• Cervical Spine - The cervical spine is the upper part of the spine and consists of 7 vertebrae.  Like the lumbar and thoracic spine, the cervical is numbered top-to-bottom C1-C7.  What's unique about the cervical spine is the top 2 cervical spine vertebrae are called the axis and atlas.  These two help form the spine to the skull, and are specialized in their shapes to allow for greater movements and freedom.  Your head can move in all those different directions because of the axis and atlas.  The cervical spine naturally forms lordosis or an inward curvature. 

• Sacrum -  The sacrum connects to the lumbar spine and is situated right between the two pelvis halves.  The sacrum consists of 5 fused bones and is a wedge shape with more width at the top and it gets skinnier as it does down.  In women the sacrum is wider, and this is a big reason for the having wider hips than males.  The sacrum is naturally kyphosis or curving outward.  At the bottom of the sacrum, lies the coccyx or better known as your tailbone.

For those of you counting, that makes 24 bones articular bone - Lumbar through Cervical - and if you include the sacrum and the coccyx (together usually 9 fused bones) it makes a grand total of 33 bones.



Look at the natural curves

 
 Vertebrae Anatomy

As you can see below, here is what a typical vertebrae looks like.  The picture is a lumbar vertebrae, and as each vertebrae you follow up the spine, it becomes a little smaller and thinner.  Some main points of attention include

• Vertebral Foramen - The hole in the middle of each spine is for... you guessed it your spinal cord.

• Spinous Process - This is what gives the spine its' name.  The process or protrusion points outward and is what can be seen and felt on your spine when looking at it from behind.  It serves as a very important attachment point for many muscles and ligaments. 

• Vertebral Body - The body of the vertebrae is the largest portion of the spine, and is set inward within the body.  The body and how each proceeding and preceding vertebrae lie help it bear the brunt of the spines weight. 

• Spinal Discs - Spinal discs lie between each vertebrae and act similar to a ligament, holding the vertebrae together and providing movement and cushioning.

• Joint Facets - Joint facets are on the posterior side of the spine and act as a hinge connection between each vertebrae.  Joint facets help control movement of the spine.  

All vertebrae from L5-C3 will carry a similar structure of what was just described.  The axis and atlas carry slightly different structure, as seen below.  Like mentioned before, the unique structures of the axis and atlas provide the great ROM abilities of your head.

 

Problems

There are many problems seen at the spine, in fact 80% of people will experience back pain at one point or another.  Most of this is acute pain, but plenty suffer from chronic back pain.  The biggest culprit of spine back occurs at the lumbar spine.  Just by looking at it's position on the spine it's understandable that it often bears the brunt of problems. 

The cervical spine also incurs a lot of pain.  With this section of the spine being let's say a little more fragile, compounded by our constant poor posture, the cervical spine often recieves pain.  Your head weights between 10-12 pounds, and for every inch forward your head posture is, that put an additional 10 pounds of force on your spine!  Now take a look at someone and look how far their ears are in front of their shoulders.  For many this may be 2-4 inches, that an additional 20-40 pounds constantly being put on your cervical spine, any question while your neck hurts?

There are a ton of injuries and problems we could include with the spine, but instead we're gonna focus on two "syndromes" that most of the population has in some form of fashion.  These syndromes are often at the root of many spinal problems, so fixing them will often help with many back problems.

Upper and Lower Crossed Syndromes

Dr. Vladimir Yanda created the Upper and Lower Crossed Syndromes through his observations of patients throughout his career.  In the most basic terms he found that joint dysfunction often results in certain patterns of muscle stiffness and weakness.  These patterns of stiffness and weakness strongly correlate with postural problems and joint dysfunctions.  The whole Crossed Syndromes can be argued with the chicken or the egg debate - does joint dysfunction cause these muscular patterns or vice versa, but the reality is these patterns can indicate potential pain and injury. 

Upper-Crossed Syndrome

The upper-crossed syndromes (UCS) refers to the upper region of the spine, and while it may not directly involve the spine, it does have a tremendous impact on spinal posture and health.  UCS is characterized by a crossing pattern of weakness and stiffness. 

So for weakness in the UCS, we tend to see weak cervical/neck flexors on the anterior aspect and crossing to the posterior side we tend to see weak lower traps and rhomboids. 

For stiffness or tightness we start with the pectoralis group on the anterior aspect and crossing over to the posterior side we see tight upper traps and scapular levators. 

Just by taking a look at the picture above, what sticks out?  Obviously the posture is poor, but if you really think about it, this is the posture many of us are in for the majority of the day.  Hunched over your computer, in your car, watching TV, or eating food.  This is the position most of us take during those activities.  Not only that but when people tend to workout, what do they do?  Watch anybody at the gym and they'll most likely be doing a thousand different variations of bench while doing little to no pulling exercises.  So our daily life and what we tend to do at the gym, over time, can lead to creating the upper-crossed syndrome. 

This creates a posture of excessive forward head position, internal rotation of the shoulder, protracted, elevated, and winging scaps, excessive thoracic kyphosis, and cervical lordosis.  There are many reasons to fix this - increased risk of neck pain, joint dysfunction especially at the C4-C5 and T4-T5 regions, reduced glenohumeral stability, and half joking but half serious, trust us we when say this is not the best way to attract members of the opposite sex.

Just take a look at how one thing can lead to another in the UCS, taken directly from Janda himself

These postural changes decrease

glenohumeral stability as the glenoid fossa becomes

more vertical due to serratus anterior weakness leading to

abduction, rotation, and winging of the scapulae. This loss of

stability requires the levator scapula and upper trapezius

to increase activation to maintain glenohumeral centration

The moral of the story is weakness or tightness in one area, for whatever reason that may be, can lead to problems elsewhere.  Remember Janda and many other clinicians have seen these same common patterns in thousands of patients, and the incidence is on the rise do to many of the lifestyles common today - more sitting, less activity, improper training.

Lower-Crossed Syndrome

Moving down to the lower region of the spine and hips is the lower-crossed syndrome (LCS).  Just like the UCS, the LCS involves criss-crossing areas of weakness and tightness. 

For weakness in the LCS we see the glutes and anterior abs lacking strength. 

For tightness we see the illiopsoas/hip flexors on the anterior side and the lumbar spine/thoracolumbar/erectors on the posterior side.



(photo: www.muscleimbalancesyndromes.com)

This pattern creates an excessive anterior pelvic tilt, excessive lumbar lordosis or hyperextension, SI Joint problems (touched upon this in hip/pelvis anatomy lesson), joint dysfunctions especially at L4-L5 and L5-S1, and even moving down the chain causing knee hyperextension.

Not only that but LCS is a major culprit in hamstring strains.  How?  With LCS you get an anterior pelvic tilt due to the glutes and anterior core is weak (and this is very common) and the hip flexors and erector spine becoming tight to help stabilize the pelvis.  This anterior tilt puts an extra stretch on the hamstrings (lengthens the origin attachment point), and because the glutes are weak, the hamstrings help to pick up their slack.  So the hammies are pulling double duty - they are over worked and constantly lengthened.  Now compound this with the fact that most will stretch their hammies because they feel "tight", when in reality this is the worst thing you can do.  Next thing you know - pop! A hamstring strain, and once you have one of those suckers they linger around forever.

Joint-By-Joint

Using the joint-by-joint as a guide we see a couple of things with the spine

• The Lumbar Spine favors stability - The lumbar does need adequate mobility and as we age we often lose that mobility, but more important than mobility for this region is stability.  Remember the lumbar spine is only 5 thick vertebrae that have to withstand the weight of the whole upper body.  It needs to provide stability and control.  Problems occur when people take the lumbar spine into end-ranges of motion over and over again.  We've all heard how someone say, "use your legs not your back".  Lifting heavy weights with a hyper-flexed or extended lumbar position is asking for trouble.  Some people can get away with it due to great amounts of co-activation from surrounding muscles, but those people have usually been training for years and are super strong.  Also things like crunches or sit-ups, thousands of reps - done day after day - for years also puts a tremendous amount of stress on your lumbar spine.

• The Thoracic Spine favors mobility - With 12 vertebrae, the thoracic spine makes up a big portion of your spine, and needs mobility.  This is an extremely important area for mobility and one that is often lacking.  This lack of range of motion will be compensated for elsewhere - lumbar spine, rib cage, shoulder, etc.  While, in our opinion, everybody could use more thoracic mobility, stability at the t-spine is still very important.  Anybody who has buckled under a heavy squat, deadlift, or Olympic lift knows the thoracic spine is often the first place to give out.  Also as touched upon in the UCS, muscles surrounding the thoracic area are often weak, and this can lead to t-spine weakness or sloppiness.   

• The Cervical Spine favors stability - Look at the make-up of the cervical vertebrae and understand they are the smallest and weakest vertebrae.  They need to be stable and controlled yet many lack that strength and control.  Again lack of adequate pulling exercises and living in cervical flexion contribute to this. 

• The Axis and Atlas favor mobility - The joint are designed for freedom and movement, yet most of the time they are "glued" down.  Try this, clench your teeth together and try touching your chin to your chest.  You SHOULD be able to do this with clenched teeth, if not you definitely have lost ROM.  Hand in hand with this is loss of rotation of the head as well.  Watch how many adults cannot even turn their heads to look out their rear view window or blind spot without having to turn their whole body.  Again you should be able to turn your head so your chin is over your shoulder without having to rotate your whole body. 

Fixes

The fixes for the crossed syndromes are pretty self-explanatory - Do the opposite of what describes the syndrome.  Pair this along with continuing to relate your training to the joint-by-joint approach and your pretty set.  So let's go over some guidelines

• Upper Body Pulls - Most programs need an overhaul of pulling movements and if you aren't keeping track of the volume of pulls to pushes, your doing yourself a dis-service.  For most people a 2:1 or even 3:1 pull to push ratio will do wonders to help correct imbalances, posture problems, performance, and pain (say those p words 5 times fast).  This means adding in more rows variations and pull-up type movements.  One of the best and easiest ways to get more pulls into your life is to do 100 band pull-aparts everyday.  This advice has been around for a long time and it's priceless.  Add in some work specific to your lower traps like OH shrugs or wall slides and your set.  So to recap more rows, pull-ups, band pull-aparts, face pulls, OH shrugs, and wall slides.  Less bench replace that shiz with push-ups

• Booty Booty Booty Rockin Everywhere - Having weak glutes ain't cool, hell glutes are the new biceps.  Not only are they great for athletic performance and keeping your body safe and strong, but everybody, guy and girl, looks for a nice pairs of buns on someone.  Hit your backside from a barrage of angles with hip thrusts, deadlifts, squats, reverse lunges, back extensions, and sprints.  Also don't forget about the ever important glute med with band walks, naughty dogs, clams, and side planks.  Hey, was your dad a baker?  Because you've got some nice buns!

• Set a Foundation - This piggy backs strengthening your glutes, and it's strengthening your "core"  What's you core exactly, well we'd say everything between your butt and chest.  While some may argue the existence of an actual core, it's hard to argue that this region does not to be strong and stable.  With the core, by our definition, including everything from the rectus abs, obliques, TVA, multifidus, pelvic floor, diaphragm, QL, serratus, glutes, psoas - you can see how many different pieces of the puzzle there are and all the connections they each will branch off to.  So there is no doubt the impact this region plays on strength, posture, and health.  Attack this region with anti-movement exercises such as planks, carry variations, pallof presses, roll-outs, and bird-dogs; then target on improving your breathing patterns; and finally connect everything together with turkish get-ups, animal walks, chops/lifts, and your core lifts.

          Check out our core collection articles for a few ideas.

• Open Your Front-side - A timeless piece of advice that will never go old says this - strengthen your non-mirror muscles and lengthen your mirror muscles.  Translation, strengthen your backside, open up your front-side.  You can never go wrong with doing extra mobility/flexibility work on your quads, hip flexors, or pecs.  While parts of your backside do need to be mobile, especially the thoracic spine, it's probably best in most situations to start with specific front-side openers. 

Conclusion

We understand there is a heck of a lot more going on at the spine than just upper and lower crossed syndromes, but it's real messy getting into disc problems, facet joint problems, and degeneration.  No body really knows how to deal with those things and research is murky on what works and what doesn't work.  So for simplicity sake, we chose to stick to the crossed syndromes.  If you can work to fix and correct those problems you'll more than likely improve your situation.  And because we're of particular interest in athletes, these fixes are imperative for improved sport performance. 

Overall we want to work on improving movement patterns, body positions, and then getting strong as hell afterwards.  Hope you learned something, and until we meet again Go Get 'Em!

Anatomy Lesson: Hip/Pelvis

Up next in our series of Anatomy Lessons is the Hip and Pelvis.  Let's first set the story straight by saying these two areas are about as complicated as they come.  The hips and pelvis essentially connect the lower body and the upper body.  There is a whole mess of things going on in this area, and it's pretty dang easy to get lost.  It's like those super highway interchanges in huge cities, on and off ramps going in every which direction. 

Basically The Hip and Pelvis
(photo: myclipta.blogspot.com)

But we're gonna try and take you through some of the basics of the hip and pelvis, and hopefully leave you with a better understanding of this area.  Don't get discouraged, this is tough stuff, and even the best out there often times need a quick reminder of these things.  So let's start this crazy adventure!

Bones

• Femur - Your big thigh bone.  At the superior (top) end of the bone is the head of the femur which fits into the acetabulum of the pelvis.

       - The femur has aspects that are also very important in the anatomy and function of the hip.  One of these includes the greater trochanter, which acts as a very important place for muscle attachments. 

• Pelvis - Comprised of the ilium, pubis, and ischium.  These bones are separate from birth until puberty when they are fused together to form the pelvis.  The pubis consists of the medial aspects, the ilium consists of the upper/superior aspects, and the ischium consists of the lower, lateral aspects.  The pelvis actually consists of two haves that connect together.

• Sacrum - This isn't really part of the hip or pelvis (technically part of the spine), but it connects the two halves of the pelvis together.  It sits on the posterior side of the pelvis fitting right between the two pelvic halves.

• Coccyx - Your tailbone, bottom portion of sacrum

• Pubic Symphysis - Not a bone, but cartilaginous joint that connects the two halves of the pelvis together

(photo: thankyourbody.com)

Muscles - The hip and pelvis are crossed by a ton of muscles.  The hip/pelvis basically connects the lower body to the upper body, so many muscles from both the lower and upper bodies play significant roles in the function of this area. So without getting way to in-depth we are going to just touch upon a few of these major muscles.

• Glutes - This includes the glute maximus, medius, and minimus.  This group is responsible for hip extension, abduction, and external rotation; as well as playing a key stabilization role.  The glutes for simplicity sake connect from different parts of the illium to different parts of the femur - this connection may not be direct, but through connective tissues or other muscles.

• Illiopsoas - The group consists of the illiacus and psoas (major and minor).  This group is grouped together because they attach the anterior part of the femur to the pelvis, with the exception of the psoas which connects to the first 5 lumbar spine.  They mainly act to flex and externally rotate the hip, but also act as pelvic stabilizers and pelvic alignment.

• Outer Abdomen - There are numerous abdomen muscles that interplay with the pelvis.  The rectus abdominus, oblique complex, erector spinae, and QL all play a role in the pelvis

• Inner Abdominal Group - This consists of the transverse abdominus (TVA), pelvic floor, diaphragm, and multifidus.  They form a cylinder shape structure with the TVA providing anterior support, the pelvic floor supporting from the bottom, the multifidus acting posteriorly, and the diaphragm supporting from the top.  These boys are instrumental in respiration function as well as pelvic/spinal stabilization and control. 

• Piriformis - The piriformis runs laterally from the sacrum to the femur.  The piriformis laterally rotates the femur with hip extension and abducts the femur with hip flexion  

• Latissimus Dorsi - The lats also connect to the iliac crest.  This connection is often through thoracolumbar fascia, but it' role on the pelvis is often under-stated.  

• Quads/Hammies - As you know from Anatomy Lesson of the Knee - These muscles groups also greatly effect the hip.  Simply the quads on the anterior side of the femur act to flex the the hip, while the hamstrings act to extend the hip.  They also act as stabilizers and help control flexion and extension eccentrically at different times.   

• Adductor Group - These are the muscles on the inside portion of your leg, better known as your groin complex.  This group mainly acts to adduct the leg. 

• Reproductive Organs - Our respective reproductive organs also play a role in pelvic structure, and provide support to the bottom aspects of the pelvis

(photo: crossfitforglory.com)

(photo: www2.ma.psu.edu)

(photo: physiodetective.com)

Movements/Alignments

• Flexion - Bringing knee towards the chest or vise versa
• Extension - Straightening leg or pulling chest away from the lower body
• Adduction - Bringing the leg towards the midline or crossing over the midline
• Abduction - Pulling the leg away from the midline
• External Rotation - Rotating the femur head away from the midline.  Can also be done by keeping a fixed leg and rotating pelvis inward
• Internal Rotation - Rotating the femur head towards the midline.  Can also be done by keeping a fixed leg and rotating the pelvis outward
• Anterior Pelvic Tilt - When the top of the pelvis tilts forward.  Think about pushing your butt out to give that Baby Got Back look
• Posterior Pelvic Tilt - Top of the pelvis tilts backwards.  Think about tucking your butt under, giving you the ever dreaded flat butt syndrome.
• Lateral Pelvic Tilt - The pelvis also has the ability to tilt or rotate laterally

(photo: joegambina.wordpress.com)

Problems

• Mobility - Going by the joint-by-joint theory, the hip favors mobility, and this is true.  The hip is a very mobile joint with the ability to move in many different planes and directions.  Problems occur when we lose ROM in our hips.  It differs in everyone, but there is a good chance you are missing mobility in some movement or another. Here are some common ROM standards you should be able to achieve

• Extension - 15-20 degrees
• Flexion - 120-130 degrees
• Adduction - 30+ degrees
• Abduction - 45+ degrees
• Internal Rotation - 45+ degrees
• External Rotation - 45-50 degrees

These are normal ranges of motion, and a loss of ability to reach these ranges could lead to increased chances of injury, dysfunction, or sub-optimal performance.  But on the same token, too much ROM, could mean some joint laxity and lack of stability, which is also not optimal.  It's the whole, more is NOT necessarily better.

• Stability - While the joint-by-joint suggests the hips favor mobility, you can easily argue it needs just as much stability.  Poor control and stability at the hip will often lead to pain or increased chance of injury elsewhere.  The hips are the power house of the body, and they need to provide strength and power.  Lack of adequate strength and stability will lead to energy leaks everywhere, and will sprinkle up and down the chain and increase chance of knee and back pain/injury

• Sacroiliac (SI) Joint - The SI joint is the joint between the sacrum and the ilium.  Remember that the sacrum is sandwiched between the two halves of the pelvis, and this means there is an SIJ on each side of the sacrum.  As you can imagine, this area requires a lot of mobility and stability, as it really connects the posterior lower body to the posterior upper body.  So despite the SIJ being joined by really strong ligaments, it can often be "pulled" by so many different demands and forces that go through the joint.  The SIJ needs a great ability to move while at other times it needs to create stability.  The SIJ can be effected by the erectors spinae, glute max, thoracolumbar fascia, TVA, lats, pelvic floor, piriformis, and biceps femoris.  So as you can see, many different muscles can affect the tension and forces on the SIJ.

• Femoral Acetabular Impingement (FAI) -  FAI is an impingement of the femur with the acetabulum, caused by irregular bone formation resulting in abnormal rub or movement in the joint.  FAI results in a limitation of hip flexion, usually limiting flexion to around 90 degrees before pain or restriction occurs.  There are 3 types of FAI (compliments of Kevin Neeld and learn more here)

1. CAM impingement - Excess bone formation around the ball of the femur. Hip flexion is limited by the bony overgrowth butting up against the top of the acetabulum.
2. Pincer impingement - An over extension or growth of the acetabular hood. The femoral neck contacts the overgrowth at a lower degree of hip flexion.
3. Mixed impingement - A combination of the CAM and pincer structural deviations.

Fixes

• Mobility - A good place to start any hip program should be to work on improving ROM in all directions.  Hip mobility is absolutely vital when it comes to knee and low back health, as well as proper function of the hips. If your hips can't move properly, then your low back and knee may compensate. Everybody is different and there is a great variance in loss of ROM from individual to individual.  Have someone qualified test to see how you fair in each range of motion so you can find out which movements may be restricted.  

I've mentioned it here before, but Kelly Starrett and his MobilityWod's are one of the best      resources around.  Doing soft tissue work, to really get in and straighten some of those tissues out also works great.  Areas like the glute max and med, piriformis, psoas, and QL/thoracolumbar fascia often respond very well to dedicated soft tissue work.  Also check out articles under the Mobility Movement Tab for ideas.  Also check out these links for some other of our favorites

Quads
Extension and Internal Rotation
Adductors

• Strength - To go along with mobility, we need to be sure to add strength and stability on top of it.  No good hip program can exist without strength work of some form.  The hip and pelvis is the connection point for the upper and lower bodies, and it oftens needs great control in order for movements to move smoothly and efficiently.  As we touched upon last time in Anatomy Lesson of the Knee, the knee follows the path set by the hip.  If the hip has poor control and sets a poor path, the knee will follow and be put at an increase risk of injury.

A good start is to add "activation" or strength exercises during warm-ups or between sets, such as naughty dogs, bird-dogs, glute bridges, band walks, prone hip extension, clams, variations of farmers walks/carries, variations of chops/lifts, and animal walks.  From there your exercise program should include a good dosage of compound lifts, such as squats, deadlifts, hip thrusts, Olympic variations, single leg variations (BSS, squat, RDL).  These exercises target the strong and powerful hip musculature from different angles or vectors, this will strengthen the hips in all areas and movements.

• Core Stability - Core stability goes hand in hand with hip and pelvis stability.  Like it's been shown above, many "core" muscle interact at the pelvis and hip.  These muscles will often assist in pelvic and hip control, and keep pelvic tilt in a good position.  The preferred method of strengthening these muscles is through forms of anti-movement instead of repetitive lengthening and shortening ie crunches/sit-ups.  So things like bird-dogs, farmer walks/carries, chop/lift variations, planks, stir the pot, landmines, turkish get-ups are all great options.  Check out articles under the Core Collection Tab to get a few ideas.

• Breathing - Like most things, breathing patterns can affect the hip and pelvis.  We talked about the inner "abs" playing a key role in pelvic stability and orientation.  The diaphragm and pelvic floor (heck it's got pelvic in it's name) are respiratory muscles and often highly dysfunctional.  To go along with the above mentioned core work, which will help strengthen the other 2 inner core muscles - TVA and multifidus, direct breathing exercises can go along way in helping function at the hip and pelvis.  Remember we take 20,000+ breaths each day, that's a huge opportunity to make giant positive changes, but on the other hand, if kept unchecked, you're just putting yourself further and further behind the 8-ball.  Good overview by Paul Ingraham here

Conclusion

Whew!  There you have it, a brief overview of the hip and pelvis.  Believe us when we say we don't fully grasp everything going on at the hip and pelvis.  There are PT's and Dr's who specifically specialize in this area, and they could tell you just how complex it is.  But we gave you the basics here today, and this info should set you straight with about 80% of the stuff happening at the Hip and Pelvis. 

If you missed the first two in this series, check them out here - Foot/Ankle and Knee
Also be sure to sign-up for BBA updates on our home page and like our Building Better Athletes Facebook page so you can stay up to date with everything going on here at BBA.  So until next time Go Get 'Em!