Eighty percent of Americans have some form of a back problem -- leading to $24 billion spent in medical costs each year directly related to low-back pain. Many Daily Health News readers have asked about exercising with back pain and if I know which exercises are gentle on the back. For options, I spoke with Karl Knopf, PhD, a leading authority on exercise for baby boomers.
Poor posture is a major contributor to back pain. Dr. Knopf believes that the first order of business for strengthening and rehabilitating the back are posture exercises, which can be practiced absolutely anywhere. "Stand upright with your weight evenly distributed over the balls of your feet and heels, with legs slightly bent. Then tilt your pelvis slightly forward so your tailbone is slightly tucked under your hips. Make the distance from your belly button to your sternum as far as possible by letting the chest rise and open, countering the "hunched over" effect. Your chin, sternum and belly button should be lined up from the front. From the side it should look like your earlobes are over your shoulders, which are over your hips." Practice that alignment whenever you are standing. When you sit, the alignment should be the same. Make sure you sit on the "sit bones" of the buttocks, not on the tailbone.
The back alone can't hold your body upright. "Think of standing a pencil upright on your desk balanced on the eraser," Dr. Knopf told me. "You could make it stand -- but it would take a lot of work and balance. How much more efficient to have guide wires? Well, the guide wires are the muscles that help keep the back aligned. These need strengthening to build a strong support system for the back.
The three basic "guide wire" muscle groups for the back are the abdominals, the gluteals (buttocks) and the perispinals (the muscles that run up and down the spine). "While many baby boomers are aware of the importance of training their abs, they often neglect the buttocks muscles, which are the other side of the guide wires. To strengthen the abs, back and glutes, Dr. Knopf recommends the following exercises...
When choosing other exercises that are gentle on the back, Dr. Knopf recommends exercises that are done with the back supported and no "load" (or weight) on the spine.
Dr. Knopf has high praise for two specific forms of exercise. "The recumbent bike is my all-time favorite," he told me. The recumbent bike, found in almost all gyms, is a bicycle (in either stationary or outdoor road versions) that allows you to sit on the bicycle as you would in a chair with your back supported, instead of upright or hunched over the way traditional bicycles do. Dr. Knopf also loves water exercise. "Vertical water exercise allows you to work all muscle groups without putting any stress or strain on the back whatsoever," he told me.
As for strength-training exercises, again, Dr. Knopf recommends those in which the back is supported and that avoid putting any "load" on it. His favorites...
Avoid: Military or shoulder press... squats.
"You have to be careful with leg exercises," Dr. Knopf told me. "If there's injury or pain, I'd prefer you do sit-to-stands. In this exercise, you sit on the edge of a chair, then stand up and sit down again. It's a "no load" version of the squat that works the front of the legs without putting any strain on the spine. You could work up to holding dumbbells in your hands to increase the resistance and build more strength.
For anyone with chronic back pain who wants to exercise and eliminate pain, Dr. Knopf strongly suggested finding a physiatrist. "They are the most underused medical specialty I know of," he told me. A physiatrist is a medical doctor who treats chronic pain and chronic conditions using a nonsurgical approach that often includes exercise. "They have no vested interest in doing surgery, and are usually very open minded to medical interventions such as chiropractic and acupuncture," said Dr. Knopf. "I've had back-pain for years, and I always make the physiatrist the captain of my ship when it comes to back-pain treatment."
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