4. The Spine

The bony part of the spine is made up of a series of separate bones called vertebrae. In humans, the vertebrae are stacked "like a column of poker chips." They are held together by the ligaments.

The number of vertebrae vary, among different species of animals but, in man, the spinal column contains 33 vertebrae, as follows:

• 7 cervical vertebrae in the neck.
  
• 12 thoracic or dorsal vertebrae in the region of the chest or thorax. These provide the attachments for twelve pairs of ribs.
  
• 5 lumbar vertebrae in the small of the back.
  
• 5 fused sacral vertebrae forming a solid bone, the sacrum, which fits like a wedge between the hip bones.

Plus a number of vertebrae which are fused together to form the bottom or base of the spine, known as the coccyx at the bottom of the sacrum.

During the fetal period, the spinal column forms a single curve with the convex surface toward the back. However, at birth, two main curvatures are present, both of which are concave forward. The upper curvature is located in the thoracic and the lower one in the sacral region. With normal development, two compensatory forward curvatures develop in the cervical and lumbar regions, just above the primary curvatures. These provide the resiliency which a stacked bone structure could not possibly provide. Unfortunately, as we have noted, a perfectly-formed spine is a rarity, indeed, in today's world.

As can be seen in the diagrams which follow, the vertebrae serve as protective housing for the spinal cord which functions in the transmission of ascending impulses from all parts of the total body up to the brain and of descending impulses and directives from the brain via the cord to all parts of the total body. This housing is known as the spinal canal. Peripheral nerves from many parts of the body enter into this housing and are affiliated with the main nerve cord. These transmit all manner of information from peripheral centers to the cord and thence to the brain and also appropriate responses from the cerebral centers back to the peripheral regions, and finally to individual cells. Every single muscular movement requires this transmission of information, the cerebral interpretation and the psychological and physical result(s) of the interpretation, the response.

4.1 Not Just a Cosmetic Problem

A spinal abnormality is not just a cosmetic problem, although that can be psychologically damaging in itself since it can lead possibly to rejection by one's peers particularly during the teen years and to depression and social isolation.

But, additionally, since all such irregularities tend to cramp all the abdominal and chest organs and can act. as an impediment to breathing, to digestion, and, in fact, to all bodily processes and will continue to do so throughout all of a shortened life, they should be corrected as early as possible and to the extent possible.

Unless mechanical corrective exercises and perhaps even braces are worn, the deformity can provide a seat for continued degenerative processes with later development of arthritis of the spine with increasingly severe back pain and disability.

The curvature tends to increase, and as it does it pushes down on the ribs attached to the spine. This in turn, narrows the chest cavity and restricts the ability of the lungs to expand. Thus, the lack of sufficient oxygen intake hampers full metabolic efficiency throughout the lifetime, which as we have noted, is usually shortened.

Dr. Hugo Keim of the Columbia University College of Physicians and Surgeons is reported to have said, "Telling a child with a scoliotic back to stand up straight is like telling a man with tuberculosis to stop coughing." Thus, most specialists insist on using the brace.

The most commonly-used brace, the Milwaukee, consists of "a leather or plastic pelvic girdle to which are attached three upright bars, one in front and two in the back. At the upper ends of the bars is a ring that circles the neck. A child wears the brace 23 hours a day, with an hour break for bathing, swimming or relaxing. Exercises are performed daily in and out of the brace. Total time in the brace averages 36 months, during which the child may take part in most of his usual activities." (Quoted from Parade, Oct. 28, 1979.)

If braces are used, they should be employed between the ages of 10 and 15, the period when growth tends to spurt and scoliosis most commonly develops. Dr. Keim maintains that exercises are not sufficient to treat scoliosis, that using the brace is a "must."

Surgery is used in about one out of every 1,000 cases and is resorted to when bracing and exercises prove inadequate or when, in the beginning, it is obvious that other measures are required. Following surgery, the patient must wear a cast that may remain in place for as long as from eight to ten or more months.

At the Hospital for Sick Children in Toronto, a Dr. Walter P. Bobechko and his colleagues are said to be experimenting with the implanting of from three to six electrodes which are inserted into muscles of the back. During the night, while the patient sleeps, "mild electrical impulses are sent to the electrodes to activate the muscles so they gradually straighten the curve." It is said that such treatment can only prove useful in young patients with at least two years' growth remaining and a curvature of less than 40 degrees.

4.2 The Missing Ingredients

All methods presently employed by the medical community depend solely on mechanical gadgets of one kind or another with the occasional administration of drugs to palliate symptoms of pain, to alter the mood when the patient becomes depressed, and/or to "biochemically balance" the mineral composition of the system. Little or no attention is given to the total spectrum of organic requisites or to the universality of the laws of life.

Even a beginning Hygienist knows that when any living creature fails to receive the tools of life, he will eventually, sooner or later, find that his health will decline and his lifespan will be shortened in an amount determined by the extent of failure to meet the organic need. There can be no doubt that the body structure will be adversely affected.

Therefore, while the Hygienist would make full application of the laws of physics and his knowledge of the fact that all healing and repair must be self-instigated, self-regulated and self-powered, s/he would also employ all the known biodynamics of life, fresh air, pure water, sunshine and warmth, all the psychological "pluses of life,"—in fact, all the many "tools" the body must have to straighten out and remodel young malformed spines.

Dr. Shelton in his book Exercise on page 262 says, "Lordosis is not difficult to correct, but the corrective work must be continued for a prolonged period." He goes on to state that this corrective work consists of training for proper posture, stretching the muscles and ligaments of the lumbar spine and strengthening the abdominal and psoas-iliacus muscles (lower end of spine), all accomplished in due course, through the patient and persistent application of muscle stretching and working in specified patterns of movement, all of which, of course, must be pursued with full attention also being paid to all other biodynamics including revision of dietary practices when necessary, daily sunbathing in the nude whenever possible, extended periods of rest and sleep, and so on.

Yesterday, while at the printers, we began talking with a woman who had heard about our interests in matters of health. She told us that her fifteen-year old daughter was afflicted with scoliosis but strangely, according to her, "No one seems to know much about it."

Upon inquiry, we learned that her daughter was receiving mineral medication in the form of multi-mineral capsules and a special pill "because she needs calcium." We asked her to what her doctor attributed her daughter's spinal abnormality and received the reply that "he said that no one knew what caused the condition and nobody knew how to treat it. She had come to the conclusion that her child would just have to live with it, meaning the scoliotic spine.

We suggested that possibly a Hygienist would be able to help her daughter and told her we'd be happy to recommend a good one to her and her daughter, one very knowledgeable about spines. We further encouraged her to study something about Natural Hygiene, that perhaps some dietary improvement might be in order. She laughed and said, "You know how these teenagers are today. I'll never get her off her hamburgers and coke!" And off she went, laughing.

Little did she realize that, in all likelihood, by such casual acceptance of the commonly-held belief that "nothing much can be done," she, in all likelihood, was condemning her child to a lifetime of low-back pain plus a multitude of allied disorders stemming from an impinged nervous system and an impaired digestive tract.

4.3 How to Detect Spinal Abnormalities

The following screening test has been devised by the Scoliosis Association.

With the client standing straight, look at the back:

1. Is one shoulder higher than the other?
   
2. Is one shoulder blade more prominent than the other?
   
3. When the arms are hanging down loosely at the sides, is the distance between the arm and body on one side greater than on the other?
   
4. Does one hip seem higher or more prominent than the other?
   
5. Does the child seem to lean to one side?

Now, with the child bending forward, arms hanging down loosely and palms touching each other at about knee level, look carefully.

1. Do you see a lump in the back in the rib area?
   
2. Is there a hump near the waist?

If the answer is yes to any of these questions, professional examination and help is probably in order.

Other visual imperfections can also be noticed as, for example:

1. Does the client have a "swayback" (lordosis)?

4.4 Typical Exercises Suitable for Mild Scoliotic Impairments

1. Test your posture by standing with your back against a wall. Learn the mechanics of good posture by trying to straighten your back. Avoid a lazy slouched posture or a too rigid posture, either of which will tend to emphasize existing curves in the back.
   
2. Straighten the curve in your neck by standing tall with the chin slightly tucked in. Standing tall, consciously, is part of the Alexander Technique. Notice how it seems to re-align every part of the body, both internally and externally.
   
3. Tall girls and boys may try to look shorter by slumping. Most short people tend to have good posture with spines well positioned. Teenagers should be encouraged to straighten the curve in the lower back (swayback) by tucking in the stomach and tilting the pelvis forward (known as the pelvic tilt).
   
4. Tighten muscles in the buttocks, bending the knees slightly.
   
5. Stand behind a straight chair. Hold on to the back. Now assume a squatting position. Maintain this position as long as possible. Repeat for from two to five or more minutes several times a day.
   
6. At work or at home, sit on a straight-backed chair. Lean forward in the chair and lower the head to your knees. Maintain this position for at least one minute. Repeat, until you can hold the position for as long as five minutes. Notice how the back muscles are being pulled.
   
7. Use the slanting board several times a day. If a slanting board is inconvenient to use, as at work, simply lie on the floor and place both legs on a chair. Press shoulders back to floor. Maintain position for from five minutes (at first beginning) to as long as thirty minutes, after practice.

Many people think that just because the muscles on their arms and legs are strong and muscular, that the muscles on the back will be in a like condition. This is not necessarily so.

The muscles of the back should be thought of as being similar to the guide-wires that support a growing tree. If these wires are strong and kept taut, the tree will grow straight and be flexible but if, however, the wires are loose and malpositioned, the tree may not fare at all well, becoming crooked.

It is the same with the spine. If the tools for proper maintenance are lacking, the spine may become crooked with swayback or some other impairment developing. Therefore, it is important for both the back and the abdominal muscles to be strengthened in all persons, but especially when a scoliotic spine is evidenced. These back and abdominal muscles are the "guide-wires" to impart strength and flexibility to the spine.

4.5 Exercises for More Severe Scoliotic Impairments

These exercises may be performed in addition to those already suggested for milder impairments of the spine.

1. Partial bending forward while maintaining a straight back. Client may sit in a chair while performing this exercise. The number of repetitions (reps) will vary with the vigor of each client. Start with five.
   
2. Sit on the floor with legs extended out in front. Lean forward and touch toes with the fingers.
   
3. Lying on the back, elevate feet and legs to vertical position pointing the toes and trying to reach the ceiling.
   
4. Place client on a table with legs extended in front of him, the knees held straight. Stand in front of subject and grasp both wrists. Have client's feet push against your abdomen. Now pull the client forward and downward as far as possible. Repeat several times.
   
5. Lie on the floor with the hands behind the head, elbows on the floor. Keeping the knees straight, raise the legs and thighs to a 45° angle. Now, extend the legs outward in opposite directions. Bring back to position. Repeat several times. Relax. Elevate again, extend, etc. Repeat several times.
   
6. Lying on the back bring the knees up on the chest. Spread the legs apart as you straighten the knees, then draw the feet together. Repeat several times without resting the legs on the floor between movements.
   
7. Assume same posture as in Exercise 6, imagine a balloon tied on a string being suspended from the ceiling. Kick the balloon away from you, using both feet simultaneously.
   
8. Lie on the back on a table. Draw one knee up on the chest while the Hygienic therapist resists the movement. Repeat using other leg.
   
9. In same position as in Exercise No. 8, flex both thighs on the chest against the applied resistance of the Hygienic therapist.
   
10. Hang on bar. Raise the knees upward until they are at right angles to the abdomen. Hold for several seconds. Relax. Repeat.
    
11. Hang on bar. Extend legs outward and upward until they are at right angles. Hold for a few seconds. Relax. Repeat.
    
12. Hanging on a bar, flex knees as in Exercise Number 10 above. Now, straighten legs outwards. Hold. Relax. Repeat.
13. Simply hang from the bar in a relaxed position for a few seconds. Repeat several times.
    

4.6 Exercises to Strengthen Abdominal Muscles

As previously noted, it is just as important to strengthen the muscles of the abdomen as those 'supporting the spine in the back. However/in this connection, it is important to choose exercises wisely.

Exercise, to be constructive, should not be easy but, on the other side of the coin, neither should they cause pain. If pain results from a particular exercise, that exercise should immediately be stopped. Pain is a body signal that injury has either occurred, or that one may be imminent. A wise precaution for therapists to follow is to do less than you should early on in working with a client. One can always add on, i.e., increase the intensiveness and/or the extensiveness of a particular muscle movement but, once an injury has resulted from the wrong kind of exercise or the manner in which a particular exercise was performed, then it is too late and further activity must be delayed until full healing has taken place, this sometimes requiring a prolonged rest—delaying progress. It is best always to keep in mind our "baby step" approach. Succeed with small successes.

The following exercises are suggested to strengthen abdominal muscles. They can be done in sequence or selections made to suit a special need.

1. Lying flat, on the back on the floor, legs outstretched in front of you, point the toes and stretch to the extent possible. Relax. Notice the pull on the abdominal muscles. This exercise strengthens ligaments and muscles that lie vertically.
   
2. This next exercise may be done in three levels of achievement.
   Lie flat on your back with both legs and thighs straight. Point the toes of both feet and raise both legs. Lower and repeat.
   The three stages of effort exerted in doing this exercise will depend, of course, upon the strength of individual muscles. It is not wise to attempt Stages 2 or 3 before gaining sufficient strength to perform Stage 1 with ease. After Stage 1 is accomplished, then the client may progress to Stage 2, and so on.
   Stage 1. Have an assistant hold down the back while another assists the client in performing the upward movement of the legs. As strength increases, less assistance should be given.
   Stage 2. The client places hands under the buttocks and lends support himself as legs are raised. An assistant may hold down the back in the early days of progression, but all assistance should eventually be abandoned as strength improves.
   Stage 3. The client should perform this exercise unassisted.
   
3. Lying on the back, raise the right leg to a vertical position. Now carry the leg across the left leg as far as you can. The goal is to touch the floor on that side. Now return the leg to its former vertical position. Repeat. Do the same exercise with the opposite leg being raised and carried to the floor on the opposite side.
   
4. Lying on the floor with the feet hooked under the bed frame or with an assistant holding the feet firmly on the floor, with arms folded across the chest, raise body up to a sitting position.
   This exercise may also be done in stages according to present capacity to perform, as follows:
   Stage 1. Instead of placing arms in the folded chest position, place hands under the buttocks to add additional support to weakened abdominal muscles. Hygienic therapist lends assistance to the upward movement by giving back support.
   Stage 2. Place hands under buttocks, feet firmly held by either an assistant or under bed frame or other restraint, raise body up to sitting position unassisted by therapist.
   Stage 3. Hands folded across chest, feet firmly planted or held, with therapist assisting upward movement, raise to sitting position.
   Stage 4. Perform exercise unassisted.
   Stage 5. Lie flat on floor, arms extended fully behind head and on floor. Throw arms forward and at the same time, sit up. No assistance. In early days, it may be well to keep knees bent or even to elevate the legs vertically and use their pull to assist the body to attain the sitting position.
   Stage 6. The difficulty of this exercise may be increased by clasping the hands behind the head and, without assistance, raising the body up to the sitting position. In performing this movement, the arms and shoulders should be held firmly back. Otherwise, this exercise has a tendency to encourage a rounding of the shoulders.
5. Twisting of the torso. Stand upright with feet slightly apart. Place hands on hips and focus eyes on a central spot on the floor. While performing this exercise, keep the eyes focused on this spot. Now, twist to the right as far as possible without straining, then to the right. Up to 20 reps. This is Stage 1.
   Stage 2. Focus eyes on a spot about half way up the wall directly ahead of you; or, if out of doors, focus on some central object. Repeat physical movement, twisting to right and left, but keep the eyes on the one spot. Up to 20 reps.
   Stage 3. Focus eyes on a spot above in front of you on ceiling. Repeat exercise as above.
   A dual benefit is received from this twisting exercise: stretching and firming of the horizontal abdominal and back muscles plus accomplishing the same for the eye muscles. Blinking the eyes after this exercise will help to relax the muscles.

4.7 Exercises to Strengthen Side Muscles

In correcting spinal imperfections, it is important to work also specifically on the side muscles. The following exercises are designed to stretch and strengthen these seldom-used muscles.

1. Stand erect, with the feet together and the arms extended over the head. Bend sideways at the waist, carrying the extended arms over slightly in advance of the head. Bend alternately from left to right but hold each bend for from 5 to 30 seconds. Keep the legs straight as you bend.
   
2. Rest weight of the body on the right bended knee. Extend left leg out to the side. Now bend the body to the right as far as possible without raising the left foot from the floor. Therapist should assist client in maintaining balance.
   
3. Repeat exercise no. 2 in the reverse position, resting weight on left knee and extending the right leg and bend to the left.
   
4. Lie on the right side on floor. Balance body with arms. Raise extended left leg until it is perpendicular with the body.
   
5. Repeat exercise no. 4 while lying on the left side. (Exercises numbers 4 and 5 may be increased in effectiveness by adding weights to ankles. These may be purchased at almost any sports store.)
   
6. Stand erect with a barbell of convenient weight suspended across shoulders and behind head. Bend alternately from one side to the other.
   
7. Rest the weight of the body on the extended right arm and on right foot. Place left hand behind head. Now lower the hips until they touch the floor. From this position, bring the body up and raise the hips until the body is arched. Lower and repeat. Therapist should support and assist on first doing this exercise and it should not be attempted until back, stomach and side muscles have shown progress.
   
8. Perform exercise no. 7 from the opposite side, resting the body weight on the feet, extending the left arm.