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Aging Spine Fitness: Evidence-Based Strengthening Techniques for Seniors: Summary 15
Exercise principles for spondylosis are as follows: • Posture and body mechanics education to minimize stress to intolerant joints • Maintain segmental mobility as able—gentle motion can prevent rate/degree of progression. • Mobilize proximal and distal segments (thoracic spine, hips) to decrease stress to affected segments Facet Joint Degeneration LEARNING TIP! Facet joints are subject to degeneration secondary to axial loading. The levels most commonly affected are L4–L5 and L5–S1. Axial load increases in the context of DDD because reduced disc height leads to increased compressive load at the facet joint, eventually causing facet joint damage. As degeneration increases, segmental motion and trunk range of motion decrease. Exercise principles for facet joint degeneration are as follows: • Use gross motion to assess segmental motion. • Determine whether to mobilize or protect based on level of degeneration and acuity. • Prioritize segmental stability (multifidus). • Mobilize proximal and distal segments (thoracic spine, hips). Lab exercises include gentle facet gliding (supine pelvic tilt anterior to posterior, cat-cow), gapping exercises (rotation, supine knee drop with opposite head rotation), and sidebend exercises (child's pose with sidebend, sitting sidebend). Spinal Stenosis Symptomatic lumbar spinal stenosis (LSS) affects approximately 10% of the population aged 55 and over; approximately 29% of asymptomatic individuals 55+ have radiographic LSS. Stenosis is the narrowing of spaces within the spinal structures, causing encroachment on neural structures. Central stenosis narrows the central spinal canal (can compress the spinal cord); lateral stenosis narrows the intervertebral foramen (can compress spinal nerve roots). Severity classification is as follows: • Mild : Narrowing of the central canal by 1/3 or less
Symptoms include back pain, paresthesia and weakness of the lower extremities, symptoms precipitated by extension and prolonged standing, and relief with forward flexion or sitting. In advanced central stenosis, fecal or urinary incontinence may be present. Exercise principles for spinal stenosis include the following: • Spinal extension exercises are CONTRAINDICATED, as are exercises involving prolonged standing. • Improve standing and walking tolerance with posterior pelvic tilt. • Stretch hip flexors: Tight psoas pulls vertebral bodies anteriorly; tight rectus femoris pulls pelvis into anterior rotation. • Strengthening should focus on segmental stability (multifidus). • Abdominal strength assists with posterior pelvic tilt. Lab exercises include sidelying assisted hip flexor stretch, posterior pelvic tilt (supine, supine with towel roll, standing), abdominal strengthening (supine, supine with towel roll), and bridging with pelvic tilt. Osteoporosis and Vertebral Compression Fractures LEARNING TIP! Osteoporosis is characterized by decreased bone mass, causing bone weakening. It is defined as bone mineral density (BMD) that is 2.5 standard deviations below average for young healthy females. It results in increased susceptibility to fractures. It is estimated that 20% of females and 4% of males older than 50 years of age have osteoporosis. Exercise principles for osteoporosis are as follows: • Exercise should be weight-bearing. • Trunk FLEXION should be avoided (risk of vertebral compression fracture). • Resistance exercises should target the bone mineral density of the hip and spine. • Optimal prescription: 2+ days/week, 8–10 exercises, 8–12 reps/set, 1–3 sets • Abdominal and glut sequencing with attention to neutral spine • Specific exercises to strengthen the erector spinae • Functional strengthening is important for control of spine position during mobility. Lab exercises include hip hinging in sitting (with and without resistance into extension), sit-to-stand with hip hinging, and mini-squats.
• Moderate : Narrowing of 1/3 to 2/3 • Severe : Narrowing greater than 2/3
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