Parkinson’s and Axial Mobility (Part 1, Cervical Spine)

“Lack of activity destroys the good condition of every human being” Plato

“If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health.” Hippocrates

Introduction: The function of our spine and all the bones and muscles, and associated tissues connected to this region are crucial for our everyday life. A prevalent injury or pain that many people typically have is usually to some part of the back. This blog post is Part 1 of 3, dealing with axial mobility, Parkinson’s, and exercises to help stretch specific back regions. A few other things to consider besides the actual task of exercising, one should also exercise the core region if the back is being targeted. Furthermore, one must consider your response to recovery from injury, quality/quantity of sleep, and the quality of your overall diet plan, especially in the presence of Parkinson’s. Let’s begin with some background about the structure and function of the spine.

*Please read the medical disclaimer at the end. And as always, a reminder, I am neither a physician nor a physical therapist , no matter how hard I try, they are the trained experts. Contact them for further details about these and other exercises.

“Attitude determines how well you do it.” Lou Holtz

Regions of the Spine: We typically identify four areas of the spine, including cervical, thoracic, lumbar, and sacral. Each part of the spine has vital physiological functions that protect the body in response to physical stress and obstacles we face every day. See the figure below.

• The cervical region of the spine is the neck region. There are seven vertebrae, which are identified as C1 through C7 from top to bottom. Cervical vertebrae support the skull, protect the brain stem and the spinal cord, and support head movement.
• The spine’s thoracic region begins where the cervical ends, and there are twelve thoracic vertebrae numbered from top to bottom as T1 through T12. Ribs attach to the thoracic vertebrae increasing their strength and offer protection of many essential organs. Thus, due to these structural features, the thoracic range of motion is limited.
• The lumbar region of the spine begins after T12 with five vertebrae identified as L1 through L5. The lumbar region is designed and poised to bear much of the body’s weight. The lumbar vertebrae are more flexible than the thoracic spine region, but they are less flexible than the cervical region.
• The sacral region of the spine is located behind the pelvis, which is numbered S1 through S5. The sacrum is a triangular-shaped region from the fusion of the sacral vertebrae. The coccyx (tailbone) is below the sacrum and is formed from the fusion of five additional bones. Think of the sacrum as a connector between the spinal cord and the pelvis. The sarum and coccyx allow us to sit upright.

“We don’t stop playing because we grow old; we grow old because we stop playing.” George Bernard Shaw

Bending and Twisting Motion of the Spine: Our daily activities require the bending and twisting of the spine. For example, you put on your seat belt when you enter the automobile and close the car door. Additionally, picking up an object that has fallen and is now behind the table next to the sofa. When you attempt numerous yoga poses, like the Cat/Cow Pose, or hitting golf balls, you need and utilize the mobility of the axial spine region.

“Health is the thing that makes you feel that now is the best time of the year.” Franklin P. Adams

Posture, Balance, and Axial Mobility in Parkinson’s:  Posture, balance, and twisting motions of the spine (axial mobility) are the foundation upon that happen from an upright stance, walking, and many of the daily actions that we complete without consciously thinking. Postural instability refers to an impairment in maintaining posture and balance, compromising the ability to quickly and efficiently maintain and change positions. Postural instability is one of the Cardinal Signs of Parkinson’s, together with bradykinesia, rigidity, and tremor, and presents in many patients at diagnosis and worsens with the progression of the disease.

As we age, many older adults develop back stiffness (rigidity) that affects many routine maneuvers. In Parkinson’s, the absence of dopamine further exacerbates the stiffness situation in the axial skeleton and regions connected therein (see the two Figures above) and alters posture and balance. Ultimately, postural instability is one of the most disabling physical symptoms of Parkinson’s. Furthermore, postural instability increases the risk of falls, is linked to loss of independence, and leads to increased depression among those with Parkinson’s. There are many stretching and exercise options to help relieve back stiffness and reduce the accompanying back pain. Here are a few suggestions and alternatives, initially targeting the neck or cervical spine region in Part 1.

“Exercise of the muscles keeps the body in health, and exercise of the brain brings peace of mind.” John Lubbock

Exercise and Parkinson’s: If you have followed this blog at all, you know my stance on the importance of exercising in the presence of Parkinson’s. Specifically, that exercise is medicine. There is substantial evidence that strenuous cardiopulmonary exercise is neuroprotective. And there are many different exercises one can perform and several Parkinson’s-specific exercise programs/routines. The goal here is to present some suggested activities to help stretch the cervical spine region and encourage you to seek individual help with a Physical Therapist (PT) trained in Parkinson’s disease therapy; it will make all the difference in the world. You can improve yourself if you challenge yourself. Furthermore, commit to exercising and stretching daily because the benefit against Parkinson’s will be notable.

Likely, you should know my favorite exercise program is still Parkinson Wellness Recovery® (PWR!®) (click here for the website), which are Parkinson’s-specific exercises named PWR!Moves®.  To learn more about PWR!Moves, click here. There are 20 different PWR!Moves exercises, done in five different positions (standing, sitting, on all-fours, on your back, and on your stomach). I encourage you to find a PT who teaches PWR!Moves classes locally where you live. Alternatively, go here for PWR!Moves classes, live and broadcast over the internet, the two links are below:

• PWR!Gym Live Virtually with Zoom, lead by Dr. Becky Farley and her incredible staff (Click here for details to join).
• Rogue Physical Therapy & Wellness, Inc., Founder, Claire McLean PT, DPT, NCS, and her awesome team (Click here for details to join).
• Please note that I have received certification to teach PWR!Moves exercises, but I only refer people-with-Parkinson’s to talk with the experts (those who teach PWR!Moves or those who use it in their practice).

“If you don’t do what’s best for your body, you’re the one who comes up on the short end.” Julius Erving

Back Problems and Parkinson’s: Remember that Parkinson’s results from the death of the mid-brain structure that synthesizes the critical neurotransmitter called dopamine. When we move, signals are sent from the brain to various parts of the spine and attached limbs to coordinate moving. While the exact mechanism is still being delineated, ultimately over the years, the spine of someone with Parkinson’s may develop scoliosis (curvature of the spine), camptocormia (forward bending of the spine), and pleurothotonus (leaning to one side).

These changes to the back can result in balance problems, back pain, and social isolation from the appearance of the person’s back. However, preceding these physical changes to the spine, muscle tightness of the various spine regions leads to postural instability and is often accompanied by pain and stiffness. Thus, frequent use of exercise programs like PWR!Moves (there are several other types of PD-specific exercise routines) will provide you an excellent foundation to use for the rest of your life.

I do realize for some of you that getting sweaty, getting on your hands and knees, or even lying flat on your back on an exercise mat is not a pleasant experience. But, remember that your fate is not final if you do not exercise, but your path forward would be smoother and fuller with exercising and stretching regularly (if possible, daily). Thus, accepting the sweat and the floor could put you in a prime position to continue your life with renewed vigor, strength, and health.

Some Exercises for the Cervical Spine Region (Neck and Shoulders): For me, I have always needed several exercises per body region. And after doing them all, I decide which ones helped the most and which exercises I will continue to use in my treatment of Parkinson’s. Importantly, if you are working with a PT, they will give you their professional opinion. Although I talked substantially about PWR!Moves as a treatment plan for Parkinson’s, I have also included specific exercises found in the internet.

1. Chin Tuck Exercise (click here).
2. Four Easy Neck Stretches (Flexion Stretch, Lateral Flexion Stretch, Levator Scapula Stretch, and Corner Stretch) (click here).
3. Stretch Your Neck Scalene Muscles (click here).
4. Neck Stretches for the Workplace from the Mayo Clinic (click here).
5. Sore-stiff back, perform the following exercise “Arms Overhead on Back Over a Rolled-up Towel.” This works well using either a rolled-up towel or cut a hollow foam pool doodle (See image below). [Note: this exercise was part of my treatment plan devised by Dr. Jennifer K. Bazan-Wigle at the PWR!Gym, Parkinson Wellness Recovery, Tucson, AZ.]
6. “Frank’s Special Desk/Work PWR!Moves Exercise Routine” (good for stretching neck and back- See image below). [Note: this exercise was part of my treatment plan devised by Dr. Rebecca R. Bliss, Fyzical Therapy and Balance Centers, Durham, NC.]
7. Bilateral Scapular Retraction and Shoulder External Rotation with Resistance Bands (click here). The entire paper is referenced here, pick the version of the exercise that is most applicable to you. This exercise is really good for upper body posture.
8. Six Resistance Band Exercises for Shoulders (click here). These are good, read the description given to determine which muscle groups of the shoulder would most benefit you. For me, it is the Standing Row and Band Pull-Apart.
9. Shoulder Work with Bands (click here). Although these exercises target golfers, these are simple and effective shoulder exercises.
10. In another part of this series, I will include some core exercises.

Medical Disclaimer Statement on Performing these Exercises
MEDICAL DISCLAIMER: Always consult your physician before beginning any exercise program. This general information is not intended to diagnose any medical condition or to replace your healthcare professional. Consult with your healthcare professional to design an appropriate exercise prescription. If you experience any pain or difficulty with these exercises, stop and consult your healthcare provider.

WHEN TO CONTACT YOUR PHYSICIAN: If you experience any symptoms of weakness, unsteadiness, light-headedness or dizziness, chest pain or pressure, nausea, or shortness of breath. Mild soreness after exercise may be experienced after beginning a new exercise. Contact your physician if the soreness does not improve after 2-3 day

“If you always put a limit on everything you do, physical or anything else. It will spread into your work and into your life. There are no limits. There are only plateaus, and you must not stay there, you must go beyond them.” Bruce Lee

Cover Image by Rolanas Valionis from Pixabay