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Aging Spine Fitness: Evidence-Based Strengthening Techniques for Seniors: Summary 13
Facet Joints Facet joints (zygapophyseal joints) are synovial articulations between adjacent vertebrae. Their orientation varies by spinal region and determines their mobility. In the thoracic spine, facet joints are oriented 60° to the transverse plane and 20° to the frontal plane, allowing lateral flexion and rotation but not flexion/ extension. LEARNING TIP! In the lumbar spine, facet joints are oriented at right angles to the transverse plane and 45° to the frontal plane, allowing flexion and extension while limiting rotation. Facet joints maintain spinal stability by accepting 6–30% of axial load. Age-related changes to facet joints include: • Articular cartilage thinning • Joint hypertrophy • Bone spur (osteophyte) formation Vertebral Body The vertebral body is the primary weight-bearing structure of the spine, increasing in size from top to bottom. Trunk flexion loads the anterior aspect of the vertebral body. With aging, there is a loss of bone mineral density, particularly in the cancellous (trabecular) bone of the interior, which undergoes structural and architectural alterations that decrease the vertebral body's strength. Osteophyte formation also occurs. Spinal Ligaments Key spinal ligaments include the ligamentum flavum (strongest; runs in front of the lamina; contains elastin; maintains spinal curvatures and assists return to upright after trunk flexion), the posterior longitudinal ligament (prevents excess flexion and posterior disc herniation), and the anterior longitudinal ligament (prevents excess extension). With aging, ligaments undergo increased elastin content (decreasing stabilizing ability) and thickening/bulging of the ligamentum flavum and posterior longitudinal ligament. Spinal Foramen The central spinal foramen houses the spinal cord; the lateral spinal foramen are openings between adjacent vertebrae where segmental nerve roots exit. With aging, patency of the spinal foramen is compromised by disc degeneration and bulging, facet joint hypertrophy, ligamentum flavum hypertrophy, and osteophyte formation . These changes cause structural encroachment into the central spinal foramen, reducing space for neural structures and making neural compression possible.
LEARNING TIP! Critically, spinal extension reduces the cross- sectional area of both the central and lateral foramen. In older adults with already-compromised foramen patency, extension can cause neural compression. Conversely, spinal flexion increases foramen patency, which explains why older adults with spinal stenosis often lean forward on grocery carts for relief.
GENERAL SPINE STRENGTHENING PROGRAM FOR OLDER ADULTS
The general spine strengthening program is based on age-related changes to the spine (not specific disease processes) and assumes: Loss of and likely pain at end- range trunk ROM; muscle imbalances (tight hip flexors, erector spinae, anterior chest; weak glut. max., glut. med., TA/abdominals, multifidus); and compensatory movement patterns. Pre-Strengthening Examination Before prescribing exercises, assess: • Gait: Sagittal plane (trunk flexion, hip extension) and frontal plane (pelvic stability, base of support) • Posture: Thoracic kyphosis/lumbar lordosis • Gross trunk motion and segmental motion • Hip mobility Stretching Component • Hip flexors: Standing or kneeling stretch • Anterior chest: Sitting, corner, or doorway stretch Thoracic Spine Mobilization Because rotation is primarily a thoracic spine function, mobilizing the thoracic spine is critical. Techniques include: Seated thoracic rotation (arms crossed, head follows), seated thoracic extension over a pool noodle or foam roller, and supine knees-to-side with opposite head rotation. Mobilizing the thoracic spine also improves rib cage mobility and breathing excursion. The instructor notes that mobilizing the thoracic spine, stretching the anterior hips, and working on abdominal tone are the three most important takeaways from this course. Abdominal Strengthening Core strengthening is critically underutilized in older adults with back pain. The program uses a neutral spine position (not fully flattened, not fully arched) for all abdominal exercises. The progression is as follows: • Abdominal isometric setting in hooklying (belly button to spine, no trunk motion) • Pick up one foot (a few inches) while maintaining neutral spine. • Unilateral tabletop (hip to 90°) while maintaining neutral spine
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