Watch Your Back
By wlr Contributor Christina Macdonald Personal Trainer and Accredited Life Coach
Want to exercise but worried about making back pain worse? Or maybe you’ve tried to exercise and found your back bothered you afterwards. Christina Macdonald reveals the best and worst types of exercise for back pain
Exercising with back pain can be a vicious circle. You may want to lose weight, so you start an exercise plan and find that it makes your back pain worse. Or perhaps you’ve been told that losing weight will alleviate your back pain in the long term, but it hurts when you try certain exercises.
In general, movement can be good for back pain and chiropractors and physiotherapists now tend to prescribe exercise rather than bed rest (except in extreme cases).
Back pain can be very debilitating and affects many people. The charity, BackCare, says that at least 80 per cent of the British population has experienced back pain at some stage in their lifetime.
Pain can be triggered by a variety of causes including sitting or standing, bending awkwardly, or lifting incorrectly, such as twisting while lifting a heavy item or leaning forward when lifting, rather than bending the knees.
Many cases of back pain are not serious and can be lifestyle related but it’s not always possible to drastically change our daily routines. That said the right types of exercise could help to reduce back pain if we choose wisely.
Best exercises for back pain
If you are completely new to exercise and you have mild back pain from too much sitting, build up a gradual base of fitness at first by doing low impact exercise like walking. However, if you’re doing lots of walking outdoors that involves climbing hills, try not to slouch. Tighten your tummy and try to keep your chest lifted to avoid aggravating your lower back.
Exercise that can make back pain worse includes high intensity activities, such as circuit training classes involving jumping, skipping, sprinting and shuttle runs.
Running is not a good choice at first due to the impact – when we run, at least three to four times our body weight is absorbed through the joints and spine.
‘Running would be the first thing to avoid because you’re going from being absolutely stiff and weak to suddenly asking your body to move quickly and absorb forces and have the strength to absorb those forces,’ says physiotherapist Mark Buckingham from Witty Pask & Buckingham (http://www.wpbphysio.co.uk).
Mark says: ‘Avoid step classes and high intensity spin classes (where you have intervals of fast pedaling) – as that would be like going from zero to hero and you’re just going to struggle. You’re going to strain things and it’s going to put you off. You don’t want to wake up the next day feeling stiff. You want to wake up feeling you have done something positive and not feel unable to walk down the stairs!’
Good exercise choices include walking, swimming, yoga and Pilates.
‘Yoga will stretch out your legs so that they are comfortably positioned behind and away from your torso, as opposed to you hunching up as you would at a desk,’ adds Mark.
Spin classes are not good idea for those who are deskbound and have tight hip flexors as it can make hips even tighter. It could also cause low back pain as your upper body is hunched over the bike. Gentle cycling at your own pace, rather than being forced to work at very high intensities during a spin class, is a better option.
If you are going to cycle, bear in mind you will be in a hunched position so it would be beneficial to stretch at the end of a ride and try to do other forms of exercise where your body is lengthening, rather than flexing forwards.
Walking may be a better choice. Exercises that lengthen the body rather than involving hunching are generally better, which is one reason why yoga is a good option.
High intensity exercise
If you want to take up higher intensity exercise like running, step or circuit training classes, it’s best to get a good base of strength first before you advance to these sort of activities. Mark recommends doing a minimum of three months’ worth of gentle exercise such as yoga, Pilates and walking before advancing into higher intensity exercise.
Pilates is perfect for improving core strength and is often associated with a reduction in back pain as it strengthens the core and lower back. Choose exercise classes carefully and make sure they aren’t too intense.
‘Have a chat with the people on the front desk of your leisure centre or gym and ask which classes are the gentler, more easy ones and which ones have a teacher that is perhaps less intense than others,’ says Mark. ‘They will know which ones are the high powered, faster classes and which are the easier ones.’
Exercise and disc problems
If you have a more serious back injury like a prolapsed disc, you may be concerned about doing any exercise. A prolapsed disc is a bulging of the disc and sitting for long periods will make it worse. When you sit, you compress all the discs in the spine and our bodies weren’t designed for long periods of sitting down.
‘Flexing of the spine puts pressure on the front part of the disc so things to avoid are flexion based activities like cycling, particularly on a racing bike,’ says Mark. ‘Swimming, which is about extending the back, can be more beneficial because it puts the spine in a position that is better for the discs because it takes pressure away from the front of the disc and spreads the load in a relatively weightless environment.’
Avoid rowing if you have a disc bulge. This can be painful for anyone with a disc problem as you’re bending right over and pushing through your legs and pulling through your arms, effectively lifting the resistance on the rower while you do it. Mark says: ‘Would you stand up and think: “a good exercise for my back is bending over and lifting a weight? Well you probably wouldn’t. Even common sense would tell you that’s not a good thing to do.”
Watch the strength work
Avoid weight training if you have a disc bulge unless you have specific guidance from a physiotherapist or chiropractor about what you can do and even then, avoid heavy weights.
If you are merely stiff in the lower back and want to do weight training, make sure your technique is spot on. A personal trainer or fitness instructor in the gym can help you. Don’t swing dumbbells when lifting and keep your back still when doing exercises like bicep curls.
Let the arms do the lifting – if your back is swinging when you are lifting then the weight is too heavy. Choose light weights if you are new to strength training in the beginning and increase the weight gradually. Aim for 12 to 15 repetitions at first, with the last two or three repetitions feeling challenging.
Make sure the movement of each exercise is slow and controlled. Avoid deep squats with a heavy bar behind your head, though gentle body weight squats may be fine if you’ve no back pain.
When you are lifting items at home, avoid twisting movements. ‘Twisting while lifting things that are probably too heavy for you, or reaching at the same time to try and get an item from one place to another is always asking for trouble,’ says Mark.
When you bend to lift an item, bend the knees and don’t just lean forward using your back. ‘People often come in to see me and say they were lifting bags from the floor or the car or lifting things in the garden,’ adds Mark. ‘It’s the bending and twisting that causes problems.’
Mark warns against getting yourself into awkward positions when gardening or doing DIY, especially if your back is already stiff. ‘It’s also things like trying to reach up to high hedges when you’ve got a stiff back. Painting the ceiling and overarching your back when it’s stiff can cause problems not just in the lower back but into the pelvis as well. It’s about avoiding extremes of movement.’
You can’t stomach it
Don’t attempt advanced stomach exercises unless your back is strong and you’re already fit. Exercises like v-sits where your feet are off the ground are quite advanced and can put pressure on the lower back.
Start with smaller stomach exercises like crunches with your feet on the floor, gently curling your shoulders off the mat (without pulling on your neck with your hands). Avoid using medicine balls and other weighted items for stomach crunches until your abdominals are strong. Working on your core strength first makes sense.
If you’re someone who tends to hurt your back through clumsy movements, or your posture is poor, you may benefit from taking up The Alexander Technique. This is a holistic method of correcting long-standing bad postural and movement patterns that cause tension in our everyday activities, which can lead to pain in the upper and lower back, neck and shoulders.
An Alexander Technique teacher will show you how to address pain caused by poor posture and improve the way you move, resulting in reduced back pain. Improvements can often be made in six classes.
The principles of the Alexander Technique involves thinking carefully about how you move, rather than switching off and zoning out, like a lot of people do when they exercise. ‘What it does is gets people to really focus and think about how they move and where they move from,’ says Mark. ‘It has many benefits from showing you how to move and how to manage worn and torn backs, and teaches you to use your whole body to minimise stress over one area.’
Weight loss will help
Finally, don’t avoid exercise altogether if you have back pain, unless you’ve been told you must rest. Gentle exercise and regular, low impact movement like walking should help in the long term. Remember exercise will help with weight loss.
Losing weight if you are overweight will also benefit your back. If you store fat around your belly, the extra weight tilts the pelvis forwards and creates more of an arch in your spine.
Mark says: ‘As your spine becomes more arched and more extended, and that posture is held for long periods of time – weeks, months or years – the spine loses its ability to flex or bend. If you try and bend it can be sore and painful because you’re trying to stretch something that has become fixed. Further, because all those spinal joints in the back are forced into a very extended and compressed position all of the time, standing and even walking can be painful.’
For more information on the Alexander Technique and to find your nearest teacher, visit http://alexandertechnique.co.uk
Witty Pask & Buckingham is based in Northampton – to make an appointment to see a physiotherapist, call 01604 601641 or email email@example.com
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