In observing and treating 50 PD patients and their 46 spouses, the most important observation this author made was that 90% of the patients, all of whom maintained their ability to walk 20 to 40 years post-PD diagnosis, had a straight spine. These patients and their elderly spouses did not stoop, paid attention to keeping their spine straight, and exercised at least an hour a day, continuing to keep their spine straight while doing so.
The spine is a lever to which the muscles that flex and extend your hips are attached. They’re among the most powerful muscles of your legs, the muscles that propel you forward. If your spine is straight, your hip flexors and extensors work optimally. If your spine is bent and you look toward the floor, it is difficult to walk with more than short shuffling steps—like someone with PD. Walking this way, you are more likely to fatigue easily and to fall. In PD, for reasons yet unknown, the spine begins to bend.
It could simply be an adjustment by your body to maintain a center of gravity. Or it could be dystonia—an unequal pull of the muscles that flex or bend the spine; atrophy—a weakening of the muscles that extend or straighten your spine; or osteoporosis. It is estimated that 50% of women and 25% of men with PD have osteoporosis. A bent spine is more likely to lead to falls, swelling of the legs, and blood clots forming in the veins of your legs (a condition known as phlebitis) A bent spine leads to your neck bending forward, making it more difficult to both chew and swallow your food.
It also creates difficulty speaking loudly and clearly. To speak or sing loudly and clearly, one’s spine must be straight and chin held up. The muscles of speaking and swallowing overlap; they both require the leverage of a straight spine in order to work effectively. Many people with PD complain of shortness of breath, though their hearts and lungs may check out as normal in an exam, because the problem is with the intercostal muscles—muscles between your ribs— which are your respiratory muscles. These muscles are affected by both aging and PD; for them to work best, your spine must be straight, giving them maximum leverage.
Your diaphragm (an accessory muscle of respiration) also works best when you are upright and your spine is straight. Sit quietly, breath normally, and count how many breaths you take in one minute. If you are taking more than 20 breaths per minute, you are likely not using the muscles of your chest wall optimally. Keeping your spine straight may help you breathe better. As your spine bends, your muscles don’t work as effectively; they no longer massage your veins effectively and this can cause fluid to back up into your feet and legs.
This swelling, or edema, can have other causes, such as heart failure, pelvic obstruction, high sodium diet, or reaction to medication. However, in many older people and those with PD, the swelling is related to inefficiency of the leg muscles. A bent spine causes the leg muscles to work at a mechanical disadvantage; they do not pump as hard or as well and cannot propel fluid from the feet to the heart, causing that fluid to accumulate in the feet. Raising your feet above you heart or massaging your legs will help the fluid “drain” back to the heart, but the best method is to start exercises that will help you maintain a straight spine and build stronger leg muscles. Many older people and people with PD have difficulty maintaining their balance. They walk well, but can easily fall.
When they fall they are unable to react quickly enough to catch themselves and break their fall. When you trip, information about the changing position of your body in space is subconsciously relayed to your brain through sensors in your feet, inner ears, and your eyes. Your body will take corrective actions to prevent or break your fall before you even realize you are falling. These corrective actions are called “righting reflexes:” reflexes that right, or correct, your position in space. Unfortunately, a bent spine impairs your righting reflexes. The exercises described in this book may improve your balance and your righting reflexes by helping you to maintain a straight spine.
Because your spine bends without your being aware of it, it is difficult to correct. Your brain is meant to survey the outside world and alert you to danger, not to keep track of your spine. Such “ordinary” housekeeping chores are assigned to a part of your subconscious brain called the basal ganglia. The basal ganglia, when they are not affected by age or PD, maintain the correct tone of the flexor and extensor muscles of your spine.
When, however, they are affected by age and PD, the flexor muscles pull more than the extensor muscles, and your spine flexes or bends. The pull of the flexor muscles on your spine is constant: when you are sitting, standing, and walking. Exercises to strengthen the opposing muscles help, but alone will not reverse the bending. To counteract the downward pull on the muscles of your spine, you must adapt strategies or habits that minimize it.
I recommend the following: The Buddha habit. Sit on a chair with your legs wide apart, approximating the Buddha’s “lotus position.” This forces your hip joints out, raises your pelvis, and straightens out your spine. Each time you sit, sit with your legs wide apart and lean your elbows on an arm-rest; this elevates your shoulder blades and further straightens out your spine. If you are sitting in a chair without arm-rests, raise your elbows and press your palms together—this also will straighten your spine.
The John F. Kennedy rocking chair. President John F. Kennedy had a bad back and used a rocking chair to relieve his pain. A rocking chair is an excellent way to maintain a straight spine, to relieve the pressure of a “bad” back, and to exercise the muscles of your legs. Choose a rocker that you can straddle, one foot on the outside of each rocker—this raises your pelvis and straightens out your spine. Lean your elbows on the arm rest—this raises your shoulder blades and further straightens your spine. Now rock! It’s a great exercise for the flexors and extensors of your hips, knees, and feet.
The General Patton stance. Stand with your hands on your hips—like General George Patton. This automatically forces your shoulder blades up and straightens out your spine. If your spine is straight you are exerting maximum leverage on the muscles of your legs; your balance will be better, you will be less likely to fall and less likely to tire. A variant on standing with your hands on your hips is to stand with your arms behind your back, hands entwined. This posture is called “parade rest.”
Think “Surprise!” While seated, raise your hands above your head, as though you are saying, “surprise.” Keep your elbows straight, reach back, and slowly touch the wall with the back of your hands. You’ll feel a pull on the extensor muscles of your spine and neck, a tug that counteracts the downward pull on them. Do this exercise 20 times a day; it supplements the habits you’ve learned to straighten your spine.
Breathing. Your ribs are attached to your spine at a 90 degree angle. If your spine is bent, your intercostal muscles are forced into an acute angle, creating a mechanical disadvantage, and they do not work as efficiently. If your spine is straight, the full effect of gravity is exerted on your diaphragm. Your diaphragm makes fuller, more complete excursions, and thus you breathe more efficiently. A bent spine limits the movement of your diaphragm, causing you to breathe faster and shallower, spend more energy on the mechanics of breathing, and become short of breath. If your inter-costal muscles and your diaphragm are not working efficiently, you are less able to cough and to bring up the secretions and food particles that can lodge in your lungs, which can lead to pneumonia.
Chewing and swallowing. If your spine is straight, your neck is also straight, and you can chew and swallow better. Chewing with an extended neck allows you to grind your food easily, with less likelihood of having a large particle of food get stuck in your throat. When your spine is straight and your chin is up, your muscles of mastication (those you use for chewing) have a mechanical advantage and thus chewing is easier.
Swallowing, however, is more complex than chewing. To swallow, you must flex your neck to prevent food from lodging in your windpipe. If there is something wrong with your teeth, gums, or throat, you will have difficulty swallowing and you will be fully aware of it. If, however, the trouble swallowing arises because of age, or disease of the basal ganglia, you may not initially be aware of the trouble. The first clue may be an unexplained weight loss, or coughing or choking while eating.
The coughing and choking are attempts by your body to get rid of the food that is sticking in your throat or getting into your lungs. If you are having difficulty chewing your food, try straddling your chair. This forces your spine, neck, and chin up. Then sit with your elbows on the table, further forcing your spine, neck, and chin up. If you make it a habit to sit while straddling your chair and keeping your elbows on the table, you will chew and swallow better, and you will be less likely to aspirate (get food caught in your throat).