August 2007

The Best Exercises

By Elliot Wagner, O.M.D., L.Ac., Doctor of Oriental Medicine

A few months ago in this column I expressed the opinion that acupuncture treatments can be a great benefit to anyone with low back pain, particularly when the problem is rooted in soft tissue — tendons, ligaments, and muscles. There are, of course, many other things you can do to help back pain. One of the best is exercise.

This question came up the other day when, talking with a patient after his treatment, he wanted to know what exercises I suggested to prevent the back pain he has suffered from, on and off, for several years.

The question has come up many times over the years, and I've developed some ideas about it. I'll tell you what I told him,but first of all you should know this: The most common cause of low back pain does not stem from vertebral pain or arthritis or other problems with the skeleton or joints. The great majority of all low back pain stems from soft tissue strain. The weight of the entire trunk rests on the vertebrae of the lower lumbar and sacral spine. This area, called the lumbosacral joint, is subject to a lot of stress and strain and, being predominantly a weight-bearing joint, it doesn't have a lot of flexibility — the pelvis can move about two inches from center, backward or forward. The ligaments that bind the bones of this joint together are made of a white tissue called collagen, which has great strength, but little elasticity. Overtime,stiffness can develop in these ligaments and the surrounding muscles and tendons, and the joint can eventually become stiff and painful.

Now, here's what I told my patient:

  1. First of all, there are useful exercises on back self-care to be found in books and on the web. Many of these can be very helpful.
  2. Many people get help using yoga, tai chi, qigong, or other non-pounding exercises. Most of these include stretching as an integral part of practice. Classes can be found locally, and you can get good results from following these programs.
  3. Kaiser and other physical therapy programs specialize in protocols for self-treatment.
  4. Any physical exercise is better than no exercise, and more exercise is usually better.
  5. For my money, the simplest and most effective exercises for low back are those that naturally integrate movement of the lumbosacral joint into the exercise. The best of these are:
    1. Walking, especially vigorous walking
    2. Swimming, especially when the kicking is done properly, with legs moving straight from the hip.
    3. NordicTrack skiing machines. This is the most boring exercise I know, and it takes about a week to get used to the skiing motion, but the way it isolates the movement of the lumbosacral joint makes it great for low back pain. A couple of weeks of NordicTrack 20 minutes a day can do wonders for your back.
    4. Dancing, especially Latin, African and Afro-Cuban dancing, or any dancing that includes shifting your weight onto one leg and straightening the other leg. You don't have to go to a club to do this. Buy a hot salsa CD or download some African drumming (great!), and dance your heart out at home! To get the motion, a little technique is helpful. The main movement is shifting the weight from one leg to the other. You shouldn't need to consciously bend your knee. As you change weight onto one leg the other leg should naturally bend at the knee and the heel of the foot raise. Whenever one leg is straight (bearing weight), the other should be bent. If this hasn't happened then your weight is probably centered. Simply shift your weight onto the appropriate leg. It may take a bit of practice to coordinate you rmovements. Just let your body relaxand do what comes naturally and, as with all these exercises, take it easy. Build skill and strength gradually, and in a few weeks you'll be surprised at how good your back feels.