Here is a question one of our recent workshop participants sent us:

I teach water and land and chair exercises to a 80 + population (98 being the oldest). I have always erred on the side of caution so when a lady in my water class objected to a SLIGHT twisting motion that I was teaching, she interrupted and said NO, my doctor said no twisting for anyone our age or with osteoporosis.

If you work with an older clientele then this sort of thing happens all the time. It is inevitable that one of your clients will tell you that their doctor told them that someone of their age should NEVER do “this” or NEVER do “that” particular exercise or motion. While I respect the hard work and expertise from medical professionals but the truth is that most of them know next to nothing about exercise and even less about biomechanical loading.

This advice is not very practical (how can you get out of a car without twisting your spine??) and also smacks of ageism. Older adults are very diverse so saying that NO ONE over a certain age should or should not do something is irresponsible. While there is typically a nugget of truth somewhere in these kinds of recommendations they go a step too far.

So is twisting “bad” for an older adult or someone with osteoporosis? It depends…

Twisting by itself is not very problematic. However, twisting torque is much more of an issue and leads to much higher levels of spinal loading and therefore much higher chances of injury. Torque is created when resistance is applied to the twisting motion. The further away from the neutral position you get the more risky torque (loading) becomes.

Sometimes it doesn’t take very much external resistance to create a lot of torque. Swinging a golf club or softball bat also creates a lot of torque…especially at the end of the motion. Most people will hurt their backs at the end of the swing when their trunk (and the club or bat) are moving quickly and their spine gets loaded quickly to stop the swing.

Many functional activities require twisting at the spine.  Even a typical gait pattern depends on spinal twisting.  However, our approach to training will either help people improve their low back pain, enhance functional movement and decrease risk of future injury….or the opposite.

Here are some guidelines that I recommend that you follow with your mature clients in regards to spinal twisting:

1. Build three-dimensional stability and endurance first:  In the neutral spinal position (which must be taught) apply resistance in all directions.  For transverse plane (rotational or twisting plane) stability I like to have clients hold a cable or resistance tube at waist height with arms slightly extended and the line of resistance perpendicular to their arms.  This creates a rotational force (torque).  Have the client hold their neutral position for 10-15 seconds while breathing lightly.  Rest 10 seconds and repeat for a total of 3 sets.  Turn around 180 degrees and repeat for 3 sets on the other side.  Other ways to create torque (that I love) in the neutral position include the standing 1 arm chest press and standing 1 arm row.
2. Teach stability with the hip hinge:  It is very difficult for most mature clients to understand how to lean forward without flexing their spine.  Obviously this is a critical aspect of being able to perform everyday functional movements while keeping the spine safe.  After teaching spinal neutral and building some endurance it is important to translate that into real-life movements.  The hip hinge is a great way to help them keep spinal neutral while bending, reaching, lifting, etc.  Many older women, I find, do NOT want to use their glutes so it takes some creative teaching to get them to slide their hips back and load their glutes in order to hip hinge effectively.
3. If you perform “full” twisting motions do so without load and under control:  Gentle spinal motion should not be an issue for most people (unless they have severe Osteoporosis or a specific injury).  Have them twist slowly (avoid ballistic movements) to almost full range of motion.  I say almost because the goal should not be to stretch further and further but rather to provide a gentle rhythmic motion for the spine.
4. When introducing load reduce the twisting range of motion:  Think of yourself standing in the middle of a clock face with 12:00 straight ahead.  When using twisting load keep range of motion in the 11:00-1:00 area which represents about 30 degrees to the right and left.  This is typically a pretty safe and functional range where some moderate loading is okay.  However, I do not recommend that you exceed this range while under load and I don’t see much of a functional purpose in doing so anyway.  Of course you must always keep the individual’s needs in mind.  Some clients may not be able to load from 11:00-1:00 without discomfort.
5. Avoid flexion and twisting at the same time:  Here is where I follow the NEVER do this type of rule simply because simultaneous flexion and rotation puts the spine in a very compromised position even under minor loading.  There are so many other great ways to train the core safely and functionally that there really is no need to perform a movement that would require flexion and rotation.

In our Functional Aging Specialist Certification course we teach fitness professionals how to develop safe and effective exercise programs for mature clients that lead to improved functional outcomes.  Become an expert in working with the exploding aging population and position yourself for many years of success in the fitness industry.