Sep 1, 2011 7:12 PM
If you have back or joint pain, there are probably some times when all you want to do is lie in bed all day. It's tempting, but it might make the problem worse. Doctors used to prescribe bed rest for back pain and other chronic pain conditions, but studies have found that people who exercise and stay flexible manage their pain much better than those who don't.
"Exercise improves your pain threshold," says Trent Nessler, PT, DPT, MPT, a vice president with Champion Sports Medicine in Birmingham, Ala. "With chronic pain, your pain threshold drops -- in other words, it takes less pain to make you feel more uncomfortable. With cardiovascular, strengthening, and flexibility exercise, you can improve that pain threshold."
If you do have a chronic pain condition like back pain or hip, knee, or shoulder problems, you shouldn't begin an exercise program without guidance. Check with your doctor first, and then seek an expert to help you develop an individualized exercise program. "Have a professional -- a physical therapist or athletic trainer -- show you what is appropriate to do given your condition," says Nessler. "I may recommend a particular exercise that's great for 75% of people, but maybe another 25% really shouldn't do it."
One thing a good trainer will do is something called a postural assessment. "We look to see how you sit, how you stand, how you walk," says Joshua Margolis, ACE, a personal trainer and founder of Mind Over Matter Fitness in New York City. "Over life, we all develop these postural imbalances. Maybe you carry a child on one hip. Maybe you carry a bag on one shoulder. These imbalances that arise as a result can often trigger pain in the back, hips, knees, and shoulders."
Margolis often recommends several simple, safe stretches that can alleviate pain in the back and other joints.
The squat is another simple exercise that can reduce your pain. "I teach all my clients to do squats," says Nessler. "If you have pain with it, there are modifications your trainer can recommend. The more you improve your ability to squat, the more you reduce your pain and improve your ability to do things like go up and down stairs.
Beyond simple stretches, one of the most important types of exercise to improve chronic back and joint pain is cardiovascular exercise, Nessler says. "Cardiovascular fitness is highly associated with a reduction in low back pain and knee pain."
The key is finding a workout that doesn't produce your pain during the exercise. You might start by walking briskly on a treadmill. If that provokes your pain, try the elliptical trainer. Still painful? Then you can try aquatic exercise -- either swimming laps, if you're comfortable with that, or participate in an organized aqua-aerobics class. "Being in the water is great for someone with joint pain," says Margolis. "It gives you a cardio workout and resistance, without putting any weight on the joints."
Strength training can also ease joint and back pain. But which is better, machines or free weights? Margolis says that both have their place. "Especially when someone is first learning how to lift, when they have a joint problem, machines can guide your movement," he says. "But the machine also simulates support that your body won't have when it's engaged in actual activity. You sit on them, you lean on them. Do a combination of free weights and machines, using more machines in the beginning and transitioning to more free weights as your strength and form improve."
Two other types of physical fitness that can help ease chronic pain are core strength and flexibility. To improve these, Nessler recommends Pilates and yoga. "They're absolutely phenomenal at reducing pain, although they should be learned under appropriate supervision, especially for someone who is dealing with an injury or a chronic pain condition."
People with joint problems that cause significant pain should usually avoid high-impact exercise. "A lot of people like to run, and it's great exercise, but it puts a lot of wear and tear on all your joints," says Margolis. "Basketball is a rough sport for the joints, too. You're jumping, landing, shifting, going in a lot of different directions."
Many people with chronic back and joint pain wonder if they can return to favorite activities like golf or tennis. Unfortunately, both of these sports tend to put great strain on the back. "Golf is a problem because it's a unilateral activity. You're only rotating one way. There's never a point where you swing the club in the other direction," explains Margolis. "Tennis is a little bit better, because at least you have a backhand and switch to a different side, but you still overuse one side. That side will get overdeveloped and overtaxed, and the other side will be neglected, leading to an imbalance."
Does that mean you have to give up golf or tennis? No. You just need to find other ways to strengthen that neglected side of your body and bring yourself back into balance. "Find a physical therapist who will teach you exercises that can offset all that repetitive motion to one side," says Nessler. The core strengthening of Pilates can do that; so can twisting and rotating exercises with a medicine ball. You can also just dial it back a bit by playing nine holes instead of 18, or two sets instead of four. Don't take a golf or tennis vacation and play five days in a row.
"With chronic pain comes a reduced quality of life," says Nessler. "Exercise can dramatically improve that quality of life again. There's no reason to be sitting around the house in pain."