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

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

Hello doctor,

I am a 52 year old male, very fit. I have rounded shoulders with slight thoracic kyphosis and sit at the desk often but do shoulder, neck, back stretching exercises regularly to combat this. I think that the main problem is coming from weakness in my thoracic spine, causing me to use arms to support myself on the desk. 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 dessicated discs that I have had since my 20s. I have had fairly tight hamstrings all my life and I have tried to stretch them intensely with a number of standard stretches, which works for a short while but they quickly become tight again. I have noticed just recently that using the leg press machine at the gym (see photo attached) is helping a lot to stretch my hamstrings.

What I am confused about however 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, 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, as well as tennis balls etc) and as I said hamstring stretching in isolation, but they have limited effect.

I am hoping this exercise will do the trick in terms of restoring 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.



Welcome to icliniq.com.

I read your concern. In my opinion, your posture is the main culprit more than strength and weakness of your thoracic musculature. I wanted to know about your low back posture and pelvic tilt.

With your narration, I presume you have weakness in the gluteus muscles which is not supporting your low back thereby causing stiffness in the hamstring and in your thoracic spine.

The relief what you get while stretching in leg press machine is not from the mere stretch but your gluteus muscles get activated and started to fire to support your lower body reducing the load placed over the hamstrings.

I feel you would have a mild stiffness in your low back while getting up early in the morning. I am not saying pain but kind of stiffness which settles within few minutes once you stretch or start to walk.

In my opinion, I suggest you the following:

Glute recruitment exercises like bridging, clamshell (10 s hold six each side), side lying and lifting leg up, lying on your stomach and lifting the leg backward, step ups, Swiss ball supported squats and isometric bridge hold (30 s hold).

While doing all these exercises, I suggest you exert pressure over the heel. Do not take weight over your toes. These exercises are to be done for 15 reps of three sets twice daily.

Stretch your abdomen muscles. Do retraction work if upper back and stretch frequently your pecs. Both pec minor and major lats. Scapular pushups, shoulder retraction help you regain your posture.

Support your low back while sitting by keeping a pillow in the low back. Hope this is helpful for you. Kindly revert back in case you need any further clarification in this regard.

For more information consult a physiotherapist online --> https://www.icliniq.com/ask-a-doctor-online/physiotherapist

Thank you doctor,

That makes a lot of sense. Whilst I do not have a lot of stiffness in my lower back in the morning that I can feel, I do have a lot of stiffness in my lower calves/ankles when I first wake which makes first walking difficult. I do have mild flat feet and I wear shoe orthotics during the days 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 and it seems to help also. What do you think about the tricep dips (photos attached)? They used to feel good when I did them but I found them awfully hard.



Welcome back to icliniq.com.

Yes, I do agree that the lower leg stiffness could be due to reduced arch in your feet as well.

The dips what you do recruits all your back muscles and scapula retracting muscles since your chest muscles are tight that may not give enough support to perform this exercises painlessly rather effortlessly. But after you did, your front chest muscles are stretched enough to make you feel the relief what you actually feel. In my opinion, you should concentrate on the recruitment of gluteus muscles which help you maintain even your arch. I recommend you to add Hip flexor stretch like cobra stretch and do that very frequently like 10 times per hour, if possible. Otherwise whenever possible. Can include glute strengthening exercises in you strength schedule. Can be done after doing recruitment exercises like bridging in the warming up.

For further queries consult a physiotherapist online --> https://www.icliniq.com/ask-a-doctor-online/physiotherapist

Thank you doctor,

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



Welcome back to icliniq.com.

Yes, I would recommend you to work on your shoulder retractors as well and external rotators. Exercises like shoulder retraction, seated rowing, IYTW's, side lying, and shoulder external rotation. These exercises will be more beneficial to you.

For more information consult a physiotherapist online --> https://www.icliniq.com/ask-a-doctor-online/physiotherapist

Thank you doctor,

So how does this look? In addition to my current three bike ride cardio workouts per week add glute/shoulder blade workout once every day:* 3 x 15 Leg Press (60kg): To recruit glutes, stretch hamstrings, stretch lower and thoracic spine, stretch/strengthen ankle and feet: rolling ankle outward slightly to combat pronation.

* 10 x Cobra Stretch: To recruit glutes and stretch hip flexor.

* Clamshell (10s hold, 6 each side): To recruit and strengthen glutes.

* 3 x 15 Tricep Dips (bodyweight): To strengthen shoulder blades and stretch chest OR IYTWs (I am not sure which to start with)?

For about three weeks? Then start to add Glute strengthening exercises.



Welcome back to icliniq.com.

In addition to your workout plan, you can start with leg press, goblet squats, step ups.

Clamshell (10 s hold) six each X 3, side-lying lifting leg sideways, single leg bridge and hip thrust can be done for 15 reps of three sets. Upper body workout as I suggested you in my earlier message retraction workout for three weeks from now.

Cobra stretch and other stretches can be performed whenever you find the time. Held for 39 s at least for five reps each.

Good warming and cool down session will help you with good recovery.

For more information consult a physiotherapist online --> https://www.icliniq.com/ask-a-doctor-online/physiotherapist

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