Episode #35: Functional Anatomy of the Spine in Barbell Training with Dr. John Petrizzo, PT, CSCS, PRSCC, SSC
Low back pain is one of the most common injuries in the general population. In all sports, including barbell training, powerlifting, and resistance training, back pain is just as common. Therefore, we should not believe that squats and deadlifts are bad for your back. In fact, they are important for increasing the health and resiliency of your spine, and decreasing your pain.
In this episode of the PRS Podcast, PRS Clinical Coaches, Drs. Rori Alter, Alyssa Haveson, and John Petrizzo discuss the functional anatomy of the spine and the role it plays in barbell training. They discuss why the spine is much more stable and resilient than medical, chiropractic, and physical therapy doctors often believe it to be, explain how barbell training improves your spine health, and how to reduce your risk for low back pain with squats and deadlifts.
This episode is an educational experience for barbell trainees, powerlifters, Crossfitters, weightlifters, and other strength lifters to deeply understand their spine to improve their training and decrease their risk for low back pain.
If you’re a chiropractor, physical therapist, medical doctor, strength coach, or student clinician, this episode is a great review and application tutorial regarding the spine and barbell training.
In this episode we discuss:
Spinal Structure
Segments of the spine
Curvatures of the spine
Vertebral body structure
Intervertebral discs
Spinal Stability
Boney alignment of the spine
Spinal ligaments
Spinal muscles
Intra abdominal pressure
Disc Structure & function
Anatomy of the intervertebral discs
Disc bulge versus disc herniation
The jelly donut analogy
Spinal Peripheral Nerves
Their role in back pain
Spinal Radiculopathy
MRIs & Imaging
Do you need an MRI?
How the spine functions in barbell training
Rigidity & force transfer
Program management for injury risk reduction
Check out the video of this episode on YouTube for images to go along with everything we discussed in this podcast episode:
Resources mentioned in this episode:
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Email: podcast@progressiverehabandstrength.com
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Alyssa IG: @alyssahope_prs
Dr. Rori Alter, PT, PRSCC, SSC: [00:00:01] The last time we recorded the new one, Alyssa and I were just like, That was so awesome. It was like a private lecture. So, people will benefit from it, especially when we're trying to break narratives (pun intended) about the back. So welcome to the Progressive Rehab & Strength Podcast. I'm your host, Dr. Rori Alter, head clinical coach here at Progressive Rehab & Strength, with my lovely co-host, Dr. Alyssa Haveson. And joining us again for a lecture by John is Dr. John Petrizzo, a clinical coach here at Progressive Rehab & Strength, a professor in Exercise Science at Adelphi University, and a physical therapist. So what we're going to do in today's podcast is talk about the general functional anatomy and kinesiology of the spine and how it relates to barbell training. Guys, if you've been around the podcast for a while, you know that last month we did an episode on the functional anatomy and kinesiology of the knee. We'll have one on the hip, and then we'll probably move to the upper body after we finish the lower body and the spine. So in this episode, we will discuss all things spine related. So John, take it away. Give us a nice little lecture here.
Dr. John Petrizzo, PT, CSCS, SSC: [00:01:34] Okay, where should we start? I think talking about the spine's structure and the vertebra first is a good starting point. So whenever we're talking about the spine, we usually specify what segment we are dealing with. So, from our perspective, we have the cervical spine, which essentially is our neck. We have the thoracic spine, which makes up our mid back, and our lower back, our lumbar spine. And then, we also have the sacrum and coccyx. So all together, we have around 33 vertebrae, seven cervical vertebrae, 12 thoracic, and five lumbar, and then the sacrum and coccygeal vertebra are all fused. So, in between those vertebrae, we have intervertebral discs and 23 intervertebral discs. We do not have an intervertebral disk at the superior portion of the cervical spine. So in between C1 and the skull and in between C1 and C2. But everywhere from C2/C3 down to L5, S1. We have an intervertebral disc in between. And obviously, the sacrum and the coccyx don't have intervertebral discs. And if we look at the overall shape of the spine, it is curved. So we have cervical and lumbar lordosis, and we have thoracic kyphosis. So if we were looking at it from the side in the sagittal plane, we would see almost an 'S' shape. Essentially, we have the cervical and lumbar lordosis like an anterior curve. And the thoracic would be a posterior curve.
Dr. Rori Alter, PT, PRSCC, SSC: [00:03:33] And for just going to chime in, because what I'm going to do with the video recording of this podcast is insert images all over the video for this step. So if you are listening to this podcast on Apple, Spotify, or wherever you listen to your podcast, whatever platform is the go, and you're just listening to the audio, might be a little confusing for you. So we will have a YouTube video of this podcast episode, and I'll insert images and stuff on that. So I think there might be a way to put images into the podcast platform, so I might be able to do that, but check this out on YouTube if you would like some images to go along with what we're talking about here.
Dr. Alyssa Haveson, PT, PRSCC, CSCS: [00:04:18] Before we get too far away from the discs. John, can you just talk a little bit about what the disks are like? Because there are many things out there referencing jelly donuts, which they're not.
Dr. John Petrizzo, PT, CSCS, SSC: [00:04:38] Well, sure.
Dr. Rori Alter, PT, PRSCC, SSC: [00:04:39] I'm going to interrupt. I'm going to direct just a little bit. Let's finish the spine structure, and then we can go into a segment specifically discussing disc anatomy because I think that is its topic in and of itself. So let's finish the curvatures and movement of the spine, and then I think we can go into the discs themselves.
Dr. Alyssa Haveson, PT, PRSCC, CSCS: [00:05:05] Don't answer that question.
Dr. Rori Alter, PT, PRSCC, SSC: [00:05:07] We're starting to get into terms with discs and curves and lordosis and kyphosis. A lot of people use these terms to describe dysfunction. And what we want you to remember is that there are normal curves in the back of our spine. So the lordosis in the lumbar spine and the cervical spine is normal. It's supposed to be there. And John, and so is the kyphosis in the thoracic spine. So, John, can you talk about the function of these curvatures in the spine?
Dr. John Petrizzo, PT, CSCS, SSC: [00:05:51] Sure. So the curvature helps to make the spine a bit more spring-like and helps us better absorb shock. So if our spine was straight, it would be more rigid, and we would be more prone to injury. So the curves are necessary. However, can they be overly exaggerated, and could that cause other issues? Yeah, they could, but we should have some degree of curvature throughout the spine, either lordosis or kyphosis, depending on the area we're discussing.
Dr. Rori Alter, PT, PRSCC, SSC: [00:06:25] Yeah. And if someone has an increased lordosis in their back or their low back or neck, a reduced lordosis or an increased kyphosis, or reduced kyphosis in their spine. That doesn't necessarily mean that anything is wrong or anything is hurting them.
Dr. John Petrizzo, PT, CSCS, SSC: [00:06:49] Of course.
Dr. Rori Alter, PT, PRSCC, SSC: [00:06:50] And you know, what's typical is what we see across most people. But what your normal is, is your normal without symptoms, without pain, what you've looked like your whole life or developed over your lifespan. So we don't worry about pain and symptoms if you don't have pain and symptoms. Right.
Dr. John Petrizzo, PT, CSCS, SSC: [00:07:13] And a lot of the research that I've seen concerning those sorts of issues, like postural changes that happen with aging and things like that, is that there's not a good correlation between someone's pain and the degree of curvature that they have. So it's not something to be overly fixated on. If you have an increased or decreased curve somewhere in your spine or you had a doctor or PT tell you to like, "oh, you know, you don't have a lumbar or lordosis, or you have an increased thoracic kyphosis" or whatever, it's it's much more about how you feel, how you're functioning than it is something like that, which is kind of a subjective thing anyway.
Dr. Rori Alter, PT, PRSCC, SSC: [00:07:55] Yeah, and structural things. So like this, we could do a whole podcast on this, and I'll write this down to have a whole podcast on it. But as an aside, our structure has pretty much been there most of our life. When you hit skeletal maturity, that's kind of when your posture sets in and your flat feet set in. And we talked about genu valgum in the knee, in the knee, and Q angle in the knee podcast. These things kind of settle in when our bones mature and we've finished growing. And if we don't have symptoms and maybe we're 30, 40, 50 years old and have an increased kyphosis relative to the general population, whereas what's typical or we have a reduced lumbar lordosis or whatever, right? Typically that has been your structure for most of your life, and the presence of pain later in life or at a certain period usually isn't correlated to your posture. It's correlated to a change in something else. So when we develop symptoms in our body, it's related to a change. Something happened, something changed or developed. And so this whole postural restoration or posture, reeducation, or improving your posture is not always the answer. Our posture can change with some injuries or progressive degeneration-type issues, but that doesn't necessarily mean that the posture was the reason something developed. Does that make sense?
Dr. John Petrizzo, PT, CSCS, SSC: [00:09:46] Yeah, I would agree with that.
Dr. Rori Alter, PT, PRSCC, SSC: [00:09:49] Alright. So back to you, John.
Dr. John Petrizzo, PT, CSCS, SSC: [00:09:53] Well, we can talk about the movement, but in terms of the structures, we have these intervertebral discs, which we'll talk more about that are wedged in between the vertebral bodies. Which are the anterior aspects of the vertebra. And then, that's where most of our compressive force will be transmitted through the spine. And then, posteriorly, we have a few structures around what we typically would refer to as the vertebral arch. So we have the spinous process, like the pointy part of the vertebra that goes straight out, straight back.
Dr. Rori Alter, PT, PRSCC, SSC: [00:10:38] You can see that. People with less body fat and less muscle, you'll see those spiny knobs on their backs. But most people you can palpate. So, at the base of your neck, you can palpate the spinous process of C7, T1, and T2 between the tops of your shoulders. And then, if you're sitting or bending all the way forward, you can usually see some of those spinous processes, right?