Women’s Health Week Podcast Series

by | Feb 26, 2021

Hello, my name is Doctor Vanessa Sammons. I’m a neurosurgeon and I’ve been working with Healthe Care for two and a half years now.

As a neurosurgeon, I’d like to talk to you today about spine health. I want to talk about the ways that ageing can affect your bones and the tissues that connect your bones. Then I will talk about what we can do to increase our strength and fitness and reduce the effect of ageing on the body to protect against pain and arthritis, particularly with respect to your spine, and to reduce neck and back pain.

The effect of ageing on bones in the form of osteoporosis—especially in women—is well known and understood. But what about the other ways that bones are affected and what about connective tissue? One thing I often talk about with patients with back and or leg pain, as well as neck pain, is that the spine is not a chain where bones are linked together, rather they’re a set of bones that have a configuration where they sit nicely next to each other, but they need to be held together by something. So what holds the vertebrae together are the intervertebral discs, the ligaments, including the ligamentous capsules around the facet joints that are on each side at the back of the spine between each vertebra, and then the muscles of the core of the body. That includes the big paraspinal muscles, the oblique muscles around the side of the abdomen, as well as the abdominal muscles. All of these tissues are biological, they’re living and they’re subject to change. We can keep them strong or we can allow them to become weak.

So what happens when we get weak muscles? that is: weak abdominal muscles and weak back muscles. These are big strong muscles that are designed to support our skeleton with taking all sorts of loads. The muscles also control movement. Without strong muscles, the loads through the spine are transmitted more through the bones and ligaments—the discs and the facet joints take more load—and without strong muscle support there’s a greater likelihood that these loads will not be even. Over time, this can lead to loss of good spinal alignment and all those forces that are sent through the spine start to be distributed through the spine in less healthy ways. For example, the disc between the vertebra might take too much load—that causes the disc to degenerate, the height of the disc lessens, and the outside of the disc can wear out and tear. These changes can cause back pain, or if the disc pushes into the nerve, it can cause leg pain or weakness. If too much of the load through the spine is taken by the facet joints at the back of the spine, these joints can become overgrown or what we call osteophytic. This can cause back pain through joint inflammation, or through damage to the ligamentous capsule of the joint if it’s stretched too much. An enlarged joint can also encroach on where the nerve exits the spine, which can again cause leg pain. There’s a lot of interplay between all of these factors, and as you might imagine, it can become a vicious cycle of pain, reduced movement, reduced strengthening, leading to loss of muscle or muscle weakness and loss of condition. That causes changes to the way the spine handles loads, and the result is degeneration.

Whilst age-related changes are inevitable to some degree, there are things we can do to minimise our chances of entering this pain and degeneration cycle. The aim is to strengthen the core—the back and abdominal muscles—so your muscles can provide a solid structure to help properly distribute the load through the skeleton. When the muscles are weak and under-used, they tighten, and the muscle shortens in length. An example of the outcome of this is a stooped posture. This occurs because number one: weak muscles across the shoulders—the trapezius muscle; number two: weak neck flexors; number three: tight pectoralis muscles, and number four: a weak trapezius and serratus anterior—which are mid-back and chest muscles. This muscle weakness and tightness pulls the posture into a stoop that changes how load travels through the entire spine. Building flexibility is also fundamental in enabling the body to maintain good posture—again, to properly allow normal forces to travel through the skeleton and spine correctly. We need the muscles to be a good length and strength, but we also need the ligaments that join the bones to bones to have a good length that facilitates the right amount of movement between the bones. There are two very important points here: anyone can become stronger and can become more flexible. You can slow down or reverse degenerative changes that occur, and exercise and strengthening is a very effective tool for prevention and treatment of back pain.

That leads to the question of what types of exercise are best. I’m a strong advocate of yoga, and of ballroom dancing, both of these types of exercise have a cognitive benefit also. Yoga is excellent for improving stress and working on mindfulness, and dancing has neuroprotective effects to help prevent dementia and other memory problems.

Firstly, let’s talk about yoga. No-one should be put off by the images of a young, fit and super flexible yogi. Yoga benefits everyone, regardless of body shape and size and it’s accessible to everyone: you don’t need special skills, you don’t need a prior level of fitness, and other than a mat, no investment is required. The intensity of yoga also varies with the effort you put into it as well as the type of yoga you choose, so you can choose low intensity or high intensity, according to how you feel that day or what your needs are at that point in time. Yoga involves a total mind and body workout and it combines strengthening and stretching poses with breathing, which can be physical and intense, or calming and relaxing. The physical benefits of yoga begin with only the most basic of practice, and the difference in flexibility and strength occurs quite rapidly, the key is regular participation. Yoga studios are abundant and there are many online options too, so there need not be any barriers. Yoga increases flexibility by stretching muscles and ligaments to some degree, leading to better posture. It takes a lot of strength to maintain a balanced pose and every muscle is used in well-rounded yoga practice, so it’s a full body workout. Importantly, with yoga, the joints are protected with correct technique so the aim of lengthening and strengthening muscles to properly support the spine and the rest of the skeleton is achieved without injury. Some modifications might be required when you’re doing yoga if you have active back pain, but with these modifications, over time you will be able to participate in normal yoga practice and with regular practice there’s a chance things can improve to really look after your back and treat back and neck pain.

Now, ballroom dancing, my other favorite method of exercise. Dancing is a physical challenge that places a lot of emphasis on developing and maintaining excellent posture. With regular participation, the core muscles achieve a good length and strength, and over time the effort required to maintain good posture reduces, so that’s giving you a lasting effect of improved posture. Again, this all works to achieve good healthy spinal alignment and distribute the loads correctly to reduce degenerative changes. Dancing has the added aerobic fitness benefits that some types of yoga don’t have. An additional benefit of ballroom dancing is the neuroprotective effect. Ballroom dancing is cognitively engaging: it requires learning new steps, remembering previously learned steps, and constantly keeping an awareness of the movements of your partner, as well as maintaining body movement to a rhythm, and in fact it’s one of the few leisure activities that has been shown to be associated with a lower risk of dementia.

I hope I have given you a better understanding of the causes of neck and back pain, as well as the hope that the existence of these pains need not be permanent, and there are things you can do to help prevent as well as treat pain, that are non-invasive and are effective.

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