The third stage of treatment in my office is Rehabilitation. This involves strengthening the "Guy Wires," or supports of the spine. If you suffer from low-back pain, the most important part of your treatment is something only you can give yourself- exercise.   By strengthening the muscles that support your back and improving your back's flexibility, exercise reduces the chances of another acute attack. Exercise in NOT to be done when in pain. This part of treatment by many back specialists is instituted on a theoretical basis, unfortunately not contingent on the patient's symptoms. More detail on curls

A full program has two parts. The first component is aerobic/movement 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, the patient must be educated in the the proper execution of the biomechanics of daily living. In other words, learning about the importance of posture and proper technique for sitting, lifting, and other activities.  

Part 1: Aerobic Exercise

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, unless you are professionally fit for the bike.

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: Low back Stretch

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:

• 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 your doctor.

Abdominal Muscles