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Q. What would be a good workout routine for me based on my health limitations?

Answered by
Sreenivasa Rao
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Feb 13, 2018 and last reviewed on: Nov 08, 2022

Hello doctor,

I am a fit 52-year-old male with rounded shoulders with slight thoracic kyphosis. And I sit at the desk often, but I do shoulder, neck, back stretching exercises regularly to combat this. I think the main problem comes from weakness in my thoracic spine, causing me to use my arms to support myself on the desk. Additionally, I think the weakness may be coming from my T11-T12 area, as it shows up as having a fairly damaged disc compared to others (see attached MRI).

Although the whole T3-T10 area seems to have desiccated discs that I have had since my 20s. I have had tight hamstrings all my life, and I have tried to stretch them intensely with a number of standard stretches, which work for a short while, but they quickly become tight again. I have recently noticed that using the leg press machine at the gym (see photo attached) is helping stretch my hamstrings.

What I am confused about is that when I keep the legs loaded, I eventually feel a great stretch and workout on my lower back and then in the T11-T12 area I mentioned earlier, directly around the joint. This seems to be the only way I seem to get to feel a release in the thoracic joints and what feels like strengthening, but it has never been recommended to me. I have done thoracic spine strengthening in isolation (using floor back extensions, tennis balls, etc.) and, as I said, hamstring stretching in isolation, but they have limited effect.

I hope this exercise will restore some flexibility and strength to my thoracic area and take some load off my upper spine and neck from the poor desk posture. I would appreciate any thoughts that you have.

Please give your suggestions.

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Hello,

Welcome to icliniq.com.

I understand your concern.

In my opinion, your posture is the main culprit more than the strength and weakness of your thoracic musculature. I wanted to know about your low back posture and pelvic tilt. From your narration, I presume you have weakness in the gluteus muscles, which do not support your low back, causing stiffness in the hamstring and your thoracic spine.

The relief you get while stretching in the leg press machine is not from the mere stretch, but your gluteus muscles get activated and start to fire to support your lower body reducing the load placed over the hamstrings. I feel you would have mild stiffness in your low back while getting up early in the morning. I do not mean pain but a stiffness that settles within a few minutes once you stretch or start to walk. So, I suggest you to follow the instructions mentioned below,

1. Do glute recruitment exercises like bridging, clamshell (do ten times and hold for six counts on each side), lying sideways and lifting the leg, lying on your stomach and lifting the leg backward, step-ups, swiss ball supported squats and isometric bridge hold (hold for 30 seconds).

2. While doing these exercises, I suggest you to exert pressure over the heel. Do not take the weight over your toes. These exercises are to be done for 15 repetitions of three sets twice daily. Stretch your abdomen muscles. Do retraction work of the upper back and stretch your pectoral muscle frequently. Both pectoral minor and major. Scapular pushups, and shoulder retraction, help you regain your posture.

3. Support your low back while sitting by keeping a pillow in the lower back.

I hope this was helpful to you.

Kindly revert if you need further clarification.


Thank you, doctor,

That makes a lot of sense. I do not have a lot of stiffness in my lower back in the morning that I can feel, but I feel a lot of stiffness in my lower calves and ankles when I first wake, which makes walking difficult initially. I have mild flat feet, and I wear shoe orthotics during the day time in my shoes to compensate for these. I have attributed the stiffness to the flat feet. Do you agree? I use the seated leg press (in the photo in my previous message) to stretch my calves and ankles, which also seems to help. What do you think about the tricep dips (I have attached the photos)? They used to feel good when I did them, but I found them hard.

Please answer.

#

Hello,

Welcome back to icliniq.com.

Yes, I agree that the lower leg stiffness could also be due to reduced arch in your feet. The dips you do recruit all your back muscles and scapula retracting muscles since your chest muscles are tight that may not give enough support to perform these exercises painlessly rather effortlessly. But after you do, your chest muscles in the front are stretched enough to make you feel the relief. In my opinion, you should concentrate on recruiting gluteus muscles which help you maintain even your arch. I recommend you to add hip flexor stretch like cobra stretch and do that frequently, like ten times per hour, if possible. Otherwise, whenever possible, you can include glute strengthening exercises in your strength schedule. It can be done after doing recruitment exercises like bridging in the warming up.

I hope this helps.

Thank you, doctor,

So, to clarify with the dips. Do you think they would be good for me to do, but may be uncomfortable at first due to chest tightness?

Please reply.

#

Hello,

Welcome back to icliniq.com.

Yes, I suggest you to work on your shoulder retractors as well as external rotators. Exercises like shoulder retraction, seated rowing, YTWs (Y-movement, T-movement, and W-movement-body and shoulder circuit workout), side lying, and shoulder external rotation should be done regularly. These exercises will be more beneficial to you.

I hope this has helped you.

Thank you, doctor,

So how does this look? In addition to my current three bike ride cardio workouts per week, I included glute and shoulder blade workouts once every day, three by 15 leg press (60kg): To recruit glutes, stretch hamstrings, stretch the lower and thoracic spine, stretch and strengthen ankle and feet. Also, I do rolling ankle outward slightly to combat pronation. In addition, I also do,

1. 10 sets of cobra stretch to recruit glutes and stretch hip flexor.

2. Clamshell (10 seconds hold, six on each side) to recruit and strengthen glutes.

3. three sets of 15 tricep dips (bodyweight) to strengthen shoulder blades and stretch chest or YTWs (I am not sure which to start with)?

Should I do it for about three weeks? After that, when can I start to add glute strengthening exercises?

Please reply.

#

Hello,

Welcome back to icliniq.com.

In addition to your workout plan, you can start with leg press, goblet squats, and step ups. Do clamshell (hold for 10 seconds) three times, side-lying and lifting leg sideways, single leg bridge, and hip thrust can be done for 15 repetitions of three sets. Do the upper body workout, as I suggested in my earlier message and the retraction workout for three weeks. Also, cobra stretches and other stretches can be performed whenever you find the time held for 39 seconds, at least for five repetitions each. A good warming and cool-down session will help you with a good recovery.

I hope this was helpful.

Hi doctor,

I have been exercising, and I feel good. I have a little difficulty with the shoulder retraction as the chest is so tight, and the spine joints are stiff. However, today I noticed that when I used the bench press differently, I could feel some activation of the muscles in the backside and stretching in the chest area. I do not make an up-and-down motion, but I just let the bar (loaded with about 30 kg) rest on my chest (kindly see the photo). I then occasionally push and pull on the bar (with my arms fully bent). Gradually I feel some good stretches across my chest and some activation of muscles in my back that I have not felt for a while.

Do you have any advice on whether I should use this or modify this? And how often should I do it?

Please answer.

#

Hello,

Welcome back to icliniq.com.

I saw the photograph you sent (attachment removed to protect the patient's identity). And I suggest you execute mild self-massage and stretch your chest muscles well and then start your bench press. This will help relax your chest and recruits your back. Even while doing shoulder retraction, follow the same to get the maximum benefit from that exercise. You can also try push-ups with push-up bars to have extra space, so your chest goes down to palm level.

I hope this is helpful to you.

Hi doctor,

Thank you for your reply.

As you recommended, I have been doing the cobra exercises to activate my glutes more. I have noticed something that I do not understand. Instead of pushing my hips into the floor, if I raise my hips slightly off the floor, I then feel a fantastic release down the front of my thighs and into the outside of my kneecaps. If I stay in this position, I feel the front of my thighs lengthen, and the front of my hips open until I naturally come down to the floor again. This beneficial effect is further enhanced by rotating my legs inward and curling my toes. To clarify, I have attached a picture of what I understand to be the start of a normal cobra pose. But I actually find myself slightly moving in the direction opposite the green arrow and holding for a few minutes to be very beneficial too. Do you have any idea why this works like this?

Please answer.

#

Hello,

Welcome back to icliniq.com.

The effect you get by lifting your hip slightly is because you stretch front-side hip joint structures and rectus femoris, a muscle that is actually a part of the quadriceps muscle that works as a weak hip flexor. These will not get stretched too much when you do normal cobra raises, as they will be supported during the movement. Further, the effect is enhanced by rotating your toes inwards as you tend to open up the anterior hip joint area giving further stretch to those structures. Those structures will always be tight due to the constant stress imposed on them due to faulty posture. If you feel good about these exercises, you can very well include them in your routine, which will benefit you.

I also suggest you to include hip mobility exercises to gain further mobility and range. Also, exercises like hip joint IR (internal rotation) stretch, fire hydrants, piriformis stretch, butterfly stretch, and figure of four positions by placing your foot under opposite side while lying on your stomach and doing cobra raises will also fetch you a relaxed feel.

I hope this clarifies your doubt.

Kindly follow up and let me know how you feel.


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