By Michael A. Amaral, MD
Spine & Sacroiliac Specialists
Atlanta, GA

These principles apply mainly to the "mature" years (above 50). This is where your training significantly differs from what you have done before. The following suggestions are really useful for everyone; however, for younger age groups they are not as important because critical muscle mass is still present and the tissues are not as susceptible to injury.

Avoid Axial Overload (Spine Compression)
"Axial load" means that the load of the weights transfers through the spine, causing compression of the vertebras and discs.

A few years ago, the teen-age population started heavy exercises. This resulted in an increase in the incidence of degenerative disc disease of the spine in this young age group, where it was previously rare. Remember that just because your muscles can do something doesn't mean that your bones, joints, discs and ligaments can take the stress.

As we get older, placing stress on the spine, even with the good intention of exercising, may accelerate degenerative disc disease. Carrying your own weight around is sufficient stimulation for normal bone maintenance. It is, however, safe to use free weights up to 15 pounds per side — to work the shoulders, for example (for a total of 30 lbs.)

There are many popular exercises that involve axial load and place stress on the spine and thus are not recommended:

• Standing heel raise, with effort at the shoulders
• Squats, with effort at the shoulders (free weights or machine)
• Free weight shrug with large weights
• Standing biceps and triceps exercises
• Simply carrying large weights around

Exercises that load the spine must be avoided! Your spine should never be between the point of effort and the point of support! This is one of the reasons to use machines instead of free weights.

You may want to favor exercises that stretch the spine instead of compressing it; for example, pull-ups or lateral pull-downs.

Work Mainly The Trunk, Not The Extremities
Working the trunk muscles also exercises the extremities. For example, bench presses to work the pectorals also work the triceps, and lateral pull-downs for the back also work the biceps. Those exercises also work the muscles of the forearms.

Along the same line of thought, leg presses are primarily used for the gluteus muscles (buttocks) but also work the quadriceps and hamstrings. If you push with the ball of the foot at the end, you also work the calves.

Muscles from the arms and legs are also the ones we use the most in the various activities of daily living.

This means that a so-called "proportional" program that requires working the arms and legs each time you work the trunk ends up over-emphasizing the extremities. You end up exercising the arms and legs proportionately more than the trunk.

This doesn't mean that you should never work out the extremities. After all, they are the ones that burn the most calories during cardiovascular exercises. What it means is that, for working all the muscles in a really proportionate fashion, you should spend more time working the trunk muscles.

Because the activities of daily living do not meaningfully provide for the maintenance of the trunk's muscles, they lose a significant amount of their bulk as we age.

But those are the muscles that will be necessary to defy old age!

Youth Is Posture
Before you're even close enough for someone to see the wrinkles, an observer can tell your age by your posture or lack thereof.

What seems to happen first, as we age, is a forward bent at the point where the thoracic spine (the spine of the chest) meets the lumbar spine (the spine of the lower back). This makes the belly protrudes.

Next, the lumbar spine flattens, losing its normal curvature and the belly protrudes more.

Finally, the normally convex curve of the upper back worsens and we really start looking old.

Not only does the lack of posture makes us look old but the compression of the vertebras that result from those postures may accelerate degenerative disk disease and spur formation (degenerative arthritis).

Ultimately, this may lead to vertebral compression fractures, if you happen to have weakness of the bones (osteoporosis).

Even without compression fractures, the chronic constriction of the lungs and guts contribute to the decreased good function of those organs.

Good Posture Requires Muscles
The only advice I have seen in most exercise books about posture is to "keep good posture," but most people do lose their good posture as they age.

The best posture is obtained when you pretend being pulled up through the top of your head.

You keep good posture with your spine, but in order to do so, the spine needs muscles to support it. This is a major point! The spine can't support itself. It needs its surrounding muscles.

Supporting muscles are the deep parallel muscles that run along it (called the longitudinal muscles), connecting one vertebra to the next and to the others. It's a bit like a tall radio antenna that needs to be stabilized by cables in order to stay up.

MRI (Magnetic Resonance Imaging) scanning is a modern technology that allows visualization of the inside of the body with great detail. It especially shows the muscles well. If you compare the MRIs of the backs of younger and older persons, you notice that the latter have significant muscle wasting. Sometimes, there is no muscle left to support the spine.

On the other hand, if you compare the muscles that lift the legs (the iliopsoas) in the same persons, the difference is not as noticeable. This is because, even as we age, we keep using our legs for walking. And this is another point: Our daily activities are not sufficient to exercise the back muscles, nor are most cardiovascular exercises. Supporting back muscles waste away progressively with age unless specifically exercised. Working other muscle groups will simply not do the job.

The deep, longitudinal back muscles (that run along the spine) are the ones we need the most as we age and they are the ones we exercise the least.

This is what happens:

• A vertebra of the spine, seen from the side, is made of 3 parts.
  • The anterior (front) part is mainly made of a mesh of bone called cancellous bone. The cancellous bone is surrounded by more solid cortical bone on the surface. Osteoporosis is mainly a weakening of the inner cancellous bone.
  • The middle part is mostly made of cortical more solid bone that forms the joints (called facets). The facets serve as pivots between the vertebrae.
  • The posterior (back) part is also mostly made of more solid cortical bone. This is where many of the back muscles and ligaments attach.
• Strong muscles and ligaments pull the posterior parts of the vertebras together. This keeps the spine straight and decreases the pressure in the front.
• As the muscles weaken, the ligaments finally also become lax. This causes more compression pressure in the front.
• Chronic compression causes the discs to degenerate and bone spurs to form. Bone spurs are a reaction of the bone to regain stability. However, too much spurring can pinch the nerve roots, causing pain. Spurs can even end up pinching the spinal cord, causing weakness. These problems often require surgery for correction. Another name for the formation of bone spurs is "degenerative arthritis".
• If the cancellous bone is weak, as seen in osteoporosis, chronic compression may result in a compression fracture of the vertebra.

Degenerative disc disease, spurs and compression fractures may all cause pain.

However, weak muscles can also cause pain on their own. This is called deconditioning.

Weak muscles are also more susceptible to strains, which can be extremely painful.

This is why resistance training is a necessity and must place more and more emphasis on the back as we age, especially the upper back, which wastes the most.

Use the time saved from not over-exercising your arms and legs to exercise your back!

Learn How Mature Athletes Can Benefit From Resistance Training
Learn the Basic Principles of Exercise for the Mature Athlete
Learn How Mature Athletes Can Avoid Injuries

Excerpt from "Being 81, Feeling 18: Slow Aging and Regain the Vitality of Youth" by Michael Amaral, MD. To order a copy of the book, send $14.95 to Spine & Sacroiliac Specialists, 550 Peachtree NE, Suite 1770, Atlanta GA 30308, or visit the Spine & Sacroiliac Specialists Web site at www.spineandsacroiliac.com.

Copyright 2006 Michael A. Amaral MD. Reprinted with permission.

The inclusion of this book excerpt on our Web site is for informational purposes only. It does not represent an endorsement by Medtronic Inc., and is not intended as a substitute for professional medical advice, diagnosis or treatment. Before starting any exercise program, always seek the advice of your physician or other qualified health professional.

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