Doctor of Chiropractic

Relieving Low-Back Pain With Exercise

If you suffer from low-back pain, the most important part of your treatment is something only you can give yourself: exercise. Regular workouts make pain go away faster. By strengthening the muscles that support your back and improving your back's flexibility, exercise reduces the chances of another acute attack.

A full program has two parts. The first component is aerobic exercise to get your whole body in good condition (aerobic exercise like walking or biking uses large muscles and gets your heart and breathing rates up). The second component is specific exercises designed to strengthen your back muscles and increase or maintain flexibility. Your doctor will tell you when to begin each type of exercise.

In addition to your exercise program, your doctor may suggest learning about the importance of posture and proper technique for sitting, lifting, and other activities. You may also need the help of a physical therapist or other professional, and may need medication for some period of time. But none of these can take the place of exercise.

Part 1: Aerobic Exercise

[FIGURE 3] The best aerobic exercises for people who have low-back pain are walking, swimming, and biking (perhaps on a stationary exercise bicycle). These allow you to work out without subjecting your back to the repeated impact produced by jogging or aerobic dance.

To keep your back and whole body (including your heart and lungs) in top condition, build up to a regular schedule of 20 to 40 minutes of exercise 3 to 5 days a week. Your workout should be strenuous enough to raise your pulse to 60% to 85% of maximum (to estimate your maximum heart rate, subtract your age from 220).

Following the guidelines below will help you succeed:

If you aren't used to exercise, start slowly. Any activity is better than none. Try to walk, at a comfortable pace, the distance of 2 to 3 telephone poles (or 2 to 3 short city blocks). With your doctor's approval, increase the pace and distance gradually: Within 3 months you should be able to achieve the full schedule.

IMPORTANT: Good posture is essential to minimize strain on your back while you exercise:

If you bike, adjust the pedals and handlebars so you can sit up straight, without leaning forward. Avoid racing bikes.

If you walk, stand comfortably straight without slouching. Preserve a slight arch in your lower back, and keep your stomach muscles slightly tensed.

Part 2: Back Exercises

A good back-exercise program helps your back in two ways: First, it strengthens and stabilizes the muscles of the back and abdomen so they can support your back and protect it from strain. Second, it keeps your back and hamstring (back of the thigh) muscles flexible. Tight back muscles are more vulnerable to injury; tight hamstrings can lead to low-back strain or sprain.

Figures 1 to 4 show exercises that many patients find helpful. However, the causes of back pain are highly individual, so your doctor will probably modify or add to these exercises. Your doctor may want to instruct you (or have an aide or physical therapist work with you) to make sure you know how to do the exercises correctly.

Be sure to follow these guidelines as you start your program: [FIGURE 4]

A little discomfort in the low-back area is natural as you get your back in condition, but sharp pain means you're pushing too hard.
Always warm up before back exercises by walking or doing gentle calisthenics.
Many people find that applying heat before exercise and ice afterward keeps discomfort to a minimum. (Some people use the reverse order; do what feels best for you).
Doing the exercises with proper form maximizes benefits and minimizes strain.
IMPORTANT: Stretches must be gentle: Never push beyond the comfort zone. Hold stretches, don't bounce.

Remember: This information is not intended as a substitute for medical treatment. Before starting an exercise program, consult a physician.

Exercising to Lose 10 to 20 Pounds

With all those low-fat, low-calorie foods to choose from and more health clubs available than ever before, you're still carrying a few extra pounds? You and more than half the country! Most Americans struggle with their weight, and many diet to lose weight.

The key to dropping those 10 to 20 extra pounds is making simple lifestyle changes. Of course, that's easy enough to say. Busy people face a number of obstacles to following a healthy diet and exercise plan, like eating a lot of restaurant meals and convenience foods and lacking time to exercise (only 1 in 10 Americans follows a consistent exercise program). But you can take many small steps to healthy living that can add up to one substantial weight-loss stride.

The pivotal trait for success? Consistency. Weight loss is best achieved by making long-term changes in diet and exercise that become part of a healthy lifestyle. Small changes that cause few disruptions in life are more sustainable and more likely to help you keep those unwanted pounds from returning home to roost.

Below are creative ways to modify your diet and physical activity. Monitoring your diet and exercise achievements in a diary can help you keep up the fight over the long haul.

Good Diet Decisions

Losing weight is a matter of mathematics. You simply need to burn more calories than you take in, thereby creating what scientists call a calorie deficit.

Many people can lose 10 to 20 pounds simply by closely monitoring their eating style. Consistently cutting out high-fat snacks and desserts, eating more fruits and vegetables, and taking smaller portions may provide the calorie deficit you need to balance your weight-control budget.

Further eating tips are provided in table 1. These steps alone may help you lose your excess pounds as you reinvent a healthy lifestyle. You may, however, need the structure provided by a low-calorie diet.

Properly designed low-calorie diets (1,200 calories per day) provide adequate nutrients and are effective for moderate weight loss. Equally important, they include enough food to keep you from feeling starved—and to keep your body's metabolic rate from falling. With very low-calorie—or "starvation"—diets, the rate at which the body burns calories while at rest (its resting metabolic rate) drops significantly, which means weight loss slows, too. See your doctor or dietitian for a diet that's right for you.

An Excellent Exercise Adventure

Exercise provides a number of health benefits (see "What You Win When You Slim" on the next page). Physical activity burns calories and helps maintain muscle mass while decreasing fat. (Maintaining muscle mass is important for a stable metabolic rate.) Exercise also improves self-esteem, which may help you stick with your healthy lifestyle habits. Finally, physical activity helps you feel better regardless of how much weight you lose.

For your weight-loss workout, choose an activity or activities that you enjoy most. Options like walking, bicycling, aerobic dancing, stair climbing, golf, tennis, jogging, and swimming are all great. Walking is a good option for many people, and it's inexpensive and readily available to most.

The overall exercise goal for weight loss is straightforward: Increase total calories burned each day. As an example, the average adult burns 100 calories by walking 1 mile (or 20 minutes). That means that previously inactive people can lose 1 pound a month simply by walking 20 minutes each day without increasing their calorie intake. Remember that any activity that burns calories should be considered as exercise (table 2).

To burn more calories, those who currently exercise 3 days a week should try adding a fourth day, exercising longer each day, or doing both. In addition to your planned daily exercise and healthy diet, you can lose extra pounds by adding more physical activity in general to your lifestyle.

Weight Loss All Over

Gradual weight loss of 1 to 2 pounds per week increases the odds of keeping weight off a long time because of the healthy behavior patterns you develop. In addition, the weight loss tends to be primarily fat, with little loss of muscle mass.

If you've heard of exercises that supposedly shave off pounds in a given body area—called "spot reducing"—forget about them. Spot reducing is not possible because calories are taken from fat stores throughout the body, not just from the area being exercised.

The amount you lose in any given area depends on how much is there in the first place. If you tend to put fat on the hips more than any other area, you will lose more fat from the hips. When you exercise a particular area of the body, the underlying muscle becomes more firm and may give the appearance of decreased weight, but the changes are related to muscle development.

Insistence on Persistence

Few people lose weight without occasional periods of discouragement and frustration. Create an attitude of persistence during times that you reach a weight plateau. In addition, some people benefit from the motivation provided by weight-loss support groups like Weight Watchers and TOPS (Take Off Pounds Sensibly). Exercise, like a healthy diet, is a lifestyle adaptation that should persist throughout life.

What You Win When You Slim

Do you need motivation to lose weight, beyond the fact that you'll feel better? Obesity has been defined as being 20% over your ideal weight. It is classified as a disease because it increases the risk of developing heart disease, certain cancers, and diabetes. Being 15% to 20% overweight also carries increased health risk when accompanied by high blood pressure, high cholesterol, smoking, or an inactive lifestyle.

The best way to prevent the complications of being obese or overweight, then, is to lose extra weight before it becomes a health risk. The benefits of losing 10 to 20 pounds include a lower risk of non-insulin-dependent (type II) diabetes, lower cholesterol, and decreased blood pressure.

Remember: This information is not intended as a substitute for medical treatment. Before starting an exercise program, consult a physician.

Low-Pressure Workouts for Hypertension

Regular exercise is a central part of your program for controlling hypertension (high blood pressure). For most people who have hypertension, a few sessions of moderate physical activity each week will reduce blood pressure significantly and lower the risk of stroke and heart attack. If your blood pressure is just mildly elevated, exercise (along with a healthy diet and lifestyle) may be enough to bring it down to normal. If you need medication, exercise probably will make it more effective, and possibly allow you to take a lower dose.

Endurance Exercise

The best type of exercise for lowering blood pressure is aerobic activity that makes you breathe faster and gets your heart rate up. This can be brisk walking, jogging, swimming, or working out with machines like a treadmill or cross-country ski simulator. Choose one or more activities that will be convenient and enjoyable to do regularly.

For maximum benefit:

Exercise three or more times each week.
Take 5 minutes to warm up (with slow walking or stretching), do 25 to 30 minutes of exercise, and then spend 5 minutes cooling down with slower activity.
Exercise hard enough to bring your pulse rate up to a level that will strengthen your cardiovascular system. To compute a target heart rate, subtract your age from 220 and multiply by 0.7. (Example: If you are 55 years old, your target rate is 115.) If your target heart rate is difficult to achieve, use a value 10% to 20% lower and build up to the target. If you're taking blood pressure medication that can reduce heart rate (such as a beta-blocker), ask your doctor about your target heart rate.
Ease into it. If you haven't been exercising, start slowly: Walk for 20 minutes, for example, at a pace relaxed enough that you can converse. Gradually build up to longer, more strenuous workouts.

Strengthening Exercises

Your doctor may also suggest a weekly session of resistance exercise to increase your overall fitness and strengthen your upper body. This may mean using light weights (like dumbbells) or doing a series of exercises with Nautilus- or Cybex-type machines.

Exercise Safely

Moderate exercise poses very little risk for most people who have high blood pressure. If you are at high risk for heart disease (for example, if you have high cholesterol, are overweight, or have a family history of early heart attack), your doctor may recommend a stress test—monitoring your heart while you exercise under supervision—to find the level of exercise best for you.

To stay on the safe side, stop exercising and consult your doctor if you experience any of the following:

Unusual discomfort in your chest, jaw, or arm;
Dizziness; or
Extreme shortness of breath.

Make It Fun

Enjoy yourself. Make it easier to exercise consistently by choosing activities you enjoy in an environment you find pleasing (like a health club, outdoors, or while listening to music). Build regular sessions into your schedule. Exercise with friends and make it a social occasion.