A recent study published in Clinical Rehabilitation found that walking can be just as beneficial as strength training in lessening chronic lower back pain.  You're never too old or out of shape to walk.  Strive to walk for up to 40 minutes to obtain the most benefit of reducing back pain.    

     First of all, it's important for you to distinguish between good pain and bad pain.  Good pain feels like a dull, aching muscular soreness which occurs when a muscle is fatigued during a reasonably intense set of an exercise.  Bad pain feels like a sharp, piercing ache which can occur during or after an exercise is performed.  Good pain should dissipate relatively soon after muscular fatigue occurs whereas bad pain may linger for a while.  
     Back pain may occur at any time and its occurrence in many cases is unexplainable.  Nevertheless, any back pain should be taken seriously as it can be quite debilitating.  Normally, your back (particularly your lower back) will be involved to some degree when performing most exercises, especially those that involve standing.  This is why it's important to strengthen your core muscles (your lower back being one of them) in order to maintain postural integrity.  In fact, poor posture due to weak core muscles may exacerbate back pain as a result of muscular imbalances.  
     If you experience back pain (especially lower back pain) while exercising, do NOT be alarmed.  Your lower back is essentially the link between your lower and upper body.  As such, the erector spinae muscles need to be strong to withstand the daily strains that occur.  Remember that dull aching pain is normal and you need not be concerned with this when performing exercises like the squat, deadlift, lunges, etc.  But if you feel sharp pain that feels severe, then it's time to take a break and give your back some time to heal and recover.  See other articles elsewhere within this blog for tips on treatment for back pain.  There may be particular exercises that simply don't work for you and seem to aggravate back pain.  If this is the case, avoid doing them.  Maintaining good posture is extremely important when executing exercises and if at any time your posture becomes compromised, this may be the cause of your back pain.  

BOTTOM LINE:  Listen to your body!  Know the distinction between good and bad pain.  Always be aware of your posture when performing exercises and when in doubt, either seek tips from a professional personal trainer or else refrain from doing the exercise.

     There is evidence as reported in  Annals of Internal Medicine (2011; 155[1], 1-9) to substantiate that massage therapy can be more effective than medications, physical therapy and exercise in reducing chronic lower back pain for up to a year.  The randomized study found that either relaxation (e.g., Swedish) or structural (e.g., deep-tissue) massage was equally as effective at reducing back pain.   
BOTTOM LINE:  Consider receiving periodic (e.g., bi-weekly) massages (in conjunction with performing regular resistance training exercises) instead of an over-reliance of medication usage as a means to reduce back pain.           

    Because yoga incorporates stretches it has been found to be quite healthy for the body and for the back in particular.  For instance, yoga can reduce back pain symptoms and improve functionality.  The benefits of yoga are largely attributed to the physical benefits of stretching and strengthening muscles.  
    Here are just some of the possible benefits of yoga:

• Promotes relaxation
• Reduces stress
• Improves balance
• Improves posture
• improves muscle tone
• Improves coordination
• Builds strength
• Improves body awareness
• Burns calories (esp. power yoga)
• Reduces body weight
• Improves breathing pattern
• Reduces blood pressure
• Reduces blood glucose levels
• Reduces cholesterol levels
• Boosts endorphin release (endorphins are chemicals which make you feel good)
• Relieves depression
• Improves sex life (e.g., cobra pose increases blood flow to the pelvis, potentially enhancing sexual function)
• Enhances sleep quality
• Boosts energy levels
• Improves concentration and ability to focus
• Increases endurance
• Increases flexibility
• Raises testosterone levels which raises libido (and yes, once again helping to improve one's sex life)
• Decreases cortisol (a stress hormone)

    The best thing you can do for your body is to exercise because moving is good for your back.  The purpose of performing exercises for lower back is twofold:

1. To lessen pain
2. To strengthen your core (i.e., lower back, abdominals, gluteals, and hamstrings)

Here are exercises that are NOT RECOMMENDED:

• Toe Touches

    This exercise may actually increase back pain because it places greater stress   on the disks and ligaments of your spine.

• Sit-ups

    This exercise primarily works the hip flexors and may place excessive pressure on your spinal disks.

• Bilateral Leg Lifts

    This exercise may also increase back pain because  it places greater stress on the spinal disks.   Better to perform unilateral leg lifts where you slowly lift one leg up while the other is bent at the knee and the foot is flat on the floor.


Here are exercises that are RECOMMENDED:

• Partial Crunches

    This exercise can help to strengthen your back and stomach muscles.  To perform this exercise properly, lie down with the knees bent and feet flat on the   mat and with the finger tips behind the head, gently tuck your abdominals inward as you raise only your shoulders off the mat. Perform 3 sets of 15 to 25 reps.

• Lying Hamstring Stretch

    This exercise requires you to bend one knee with the foot flat on the mat and raise the other leg before gently straightening the lifted leg  (note:  a towel or band is recommended for wrapping around the lifted leg in order to provide leverage and allowing for increased stretch).  Perform 3 sets of 30-second stretches for each leg.

• Wall Sits 
  

    This exercise is an isometric exercise which entails standing about a foot away from a wall, leaning back so that your back is flat against the wall, and slowly sliding down until your knees are at a 90-degree angle.  Hold this position for as long as you can before rising upward.  Repeat 3 times.

• Half-Cobra Stretch

    Lie on your stomach with palms down and elbows under the shoulders.  Push your elbows downward and hold for a moment before relaxing.  Repeat 3 times.

• Bird Dog

     Kneel on hands and knees before lifting one arm and opposite leg upward.  Be sure to keep the hips level and the elbow and knee of the lifted limbs as straight as possible.  Hold the lifted position for a moment and alternate limbs.  Perform 3 sets of 12 to 15 reps per side.

• Knee-to-Chest Stretch

    Lie on your back with bent knees with feet flat on the floor.  Now lift one leg and pull the knee toward your chest.  Be sure to keep the lower back pressed into the floor while doing this position.  Hold the stretch for up to 30 seconds and then switch sides.  Perform this stretch 3 times on each side.

• Pelvic Tilts

    Lie on your back with knees bent and feet flat on the floor.  Tighten your stomach and pull your belly button toward your spine.  Your lower back should be pressing into the floor as you do this while your hips and pelvis should rock back and forth.  Hold each position for a moment and release.  Perform 3 sets of 8 to 12 repetitions of this exercise.

• Bridging

    Lie on your back with knees bent and heels into the floor.  Now push your heels downward, squeeze your butt,  and lift your hips off the floor.  Your shoulders, hips and knees should be lined up at the top position.  Hold the position briefly and release.  Perform 3 sets of 8 to 12 repetitions of this exercise.

• Light Weight Lifting 
  

    A personal trainer can provide guidance in terms of which exercises are best to avoid aggravating back pain.

• Cardio Exercise

    Best exercises are walking, biking and swimming.  Swimming is highly recommended due to the buoyancy of water to allow for back support.

     Poor posture is usually indicative of weak and/or tight core muscles (e.g., weak erector spinae, weak gluteals, weak abdominals, and especially tight hamstrings).  Your posture is tremendously affected by how you "hold" your body throughout the day.  If you slump in your chair most of the day with your shoulders hunched over and your lower back in perpetual excessive stretch, your body will respond accordingly (i.e., sunken chest, chronic lower back pain).  It is essential to strengthen as well as stretch your core muscles to alleviate the tendency to assume bad posture.  The solution to alleviating lower back pain does NOT come in a pill.  You must strengthen your core muscles, especially your abdominals and lumbar.  
     Some key aspects to focus on while performing the following exercises include:

• Draw in your naval toward your spine
• Move s-l-o-w-l-y but purposely
• Breathe evenly and do NOT hold your breath

     Here are some recommended exercises to get you on the right path toward having better posture:

• Single knee tuck

          Execution:  Lie on your back and pull in one knee while extending and elevating the other leg to about 45 degrees.  Flatten your lower back against the floor and draw in your navel toward your spine.  If your lower back arches, raise the elevated leg higher.  Perform 12 to 15 leg raises per side.

• Curl-up

          Execution:  Lie on your back with knees bent and feet flat on the floor.  Flatten your lower back against the floor and draw in your navel toward your spine.  Now press each hand against your thighs while lifting your head and shoulders off the floor.  Hold the top position briefly before s-l-o-w-l-y lowering your back against the floor.   Ideally, only your lower back should contact the floor on the descent.   Perform 12 to 15 curl-ups.

• Sit-up

           Execution:  Lie on your back with legs extended and flat on the floor.  Flatten your lower back against the floor and draw in your navel toward your spine.  Now raise your arms (elbows straight) over your shoulders with thumbs interlocked while lifting your head and shoulders off the floor.  Continually raise your body, one vertebra at a time until you are in a full sit-up position.   Perform 12 to 15 sit-ups.

• Bicycles

            Execution:  Lie on your back with one knee tucked in and the other leg extended and elevated.  Flatten your lower back against the floor and draw in your navel toward your spine.  Now place your hands behind your head and rotate one elbow to its opposite knee.  Rotate to the other side as you draw in the other knee while extending the opposite leg.  Perform these movements in a s-l-o-w fashion to achieve the most benefit.  Perform 12 to 15 rotations.

• Cobra with hyperextension

           Execution:  Lie on your stomach with palms flat on the floor beside your ribs and legs extended.  Draw in your naval toward your spine and lift your chest and legs off the floor without bending your knees.  Pause in the top position before s-l-o-w-l-y lowering your body to the floor.  Perform 12 to 15 reps.

• Plank

           Execution:  Get down onto the floor with hands/elbows and knees with palms/elbows under the shoulders.  Extend both legs behind you with toes pointed toward the floor (i.e., initial push-up position).  Drop your hips to achieve an alignment while drawing in your naval toward your spine.  Be sure to look only slightly ahead but still in a downward direction.  Hold this position for a duration of one minute.  Perform this posture 2 to 3 times. 

    Sitting actually compresses the spine more than standing.  The greater intradiscal pressure can cause nerve impingement and degenerative osteoarthritic changes.  Always remember to take periodic breaks (an alarm set to go off hourly helps) and stand up and walk around to lessen muscular aches and pain.
    Here are some recommendations for you to do to help minimize lower back pain:

• Limit the duration of time you spend sitting
• Support your lumbar while sitting in your chair (e.g., use a rolled up towel held within rubber bands or a specially-designed foam roller)
• Your chair should have arm rests 
• Your chair should be able to recline (optimum angle is 120 degrees)
• Sit with your knees open
• Place your feet on a small step to reduce lumbar strain
• Purchase an ergonomic chair suitable for the height of your desk
• Chair height should allow you to rest your elbows on your desk without shrugging your shoulders or leaning forward

    The benefits of good posture are numerous and cannot be overstated as the nature of your health and wellness later in life may depend on your posture now.  That is, if your posture is poor (i.e., rounded shoulders, drooped head, etc.) due to sedentary behavior (i.e., sitting for extended periods of time in front of a computer), adverse effects on your body will become more apparent down the road.  Such conditions as joint osteoarthritis and spinal misalignments may develop due to stresses incurred as a result of poor posture.   Good posture means drawing your chin back, relaxing your shoulders, stretching your chest forward, tucking your navel toward your spine, sitting with your knees lower than your hips, and having both feet planted firmly on the floor.

    Here are some benefits of having a good posture:

• Efficient function of your internal organs (i.e., rounded shoulders can affect the function of lungs and therefore breathing capacity due to constriction in the chest cage)
• Efficient function of your limbs (i.e., forward-facing feet and legs while running)
• Improves exercise performance (i.e., tight hamstrings can affect your ability to properly perform a squat or deadlift due an inability to arch the lower back) 
• Reduces back pain
• Boosts metabolism
• Improves feelings with regard to your body
• Enhances self-esteem
• Enhances sense of self-confidence and how confident you look to others
• Enhances sense of attractiveness
• Enhances ease of movement
• Optimizes breathing
• Keeps your blood pressure in check
• Improves core strength
• Increases testosterone levels
• Lowers cortisol levels
• Lowers inhibitions
• Reduces joint stress
• Improves balance between your muscle strength and flexibility
• Decreases risk of falls
• Reduces headache frequency
• Optimizes movement efficiency

    Here are some self-check methods to assess your posture for any deviations from good posture:

1. Mirror assessment.   Stand sideways to a full-length mirror.  Close your eyes, bend forward, then stand up quickly and gaze at the mirror to check your posture.  Are your shoulders slumped?  Is your head tilted forward?  Does your chest have the appearance of being caved in as if someone just punched you in the sternum?  Is your lower back flat or excessively arched?  Ideally, your posture would be considered good if your shoulders are pulled back, your head is upright, your chest is expanded, and your lower back is in a neutral position (i.e., not flat but not excessively arched either).  Now turn and face directly to the mirror and check your posture for symmetry.  Is your head tilted to one side?  Are your shoulders misaligned?  Are your hips misaligned?  Are your knees lined up?   Your head should not be tilted to the side, shoulders and hips should be aligned and knees should be lined up.
2. Wall assessment.   Stand with your back against a wall.  Do your heels, calves, butt, upper back, and head touch the wall?  If not, there may be some postural deviation in your body.  
3. Hanging string with weight.   Find a piece of string at least six feet in length and attach a small object to one end.  Fasten the other end of the string to a ceiling in front of your mirror.    Now stand directly behind the string so that it bisects your body and look at your image in the mirror.  The string is a reference line for you to compare the symmetrical appearance of your shoulders, hips, and knees.       

  
     For your information, here are some postural misalignment terms and their possible causes:

• Lordosis--excessive anterior pelvic tilt (i.e., excessive lumbar arch)

           Possible cause(s):  tight hip flexors and/or lumbar spinal erectors and weak abdominals and/or hip extensors

• Kyphosis--excessive anterior-posterior spinal curvature (i.e., hunched upper back)

           Possible cause(s):  tight obliques, pecs, and/or lats and weak thoracic spinal erectors and/or mid/lower traps

• Flat back--posterior pelvic tilt (i.e., insignificant lumbar arch)

           Possible cause(s):  tight hamstrings, abdominals, and/or hip extensors and weak lumbar spinal erectors and/or hip flexors

• Forward head--excessive neck protrusion (i.e., jutting neck)

           Possible cause(s):  tight neck extensors and/or upper traps and weak neck flexors        


    You don't have to live with aches and pains in your body as a result of misaligned joints from poor posture.  Physical therapy, chiropractic care as well as the services of a good personal trainer can rectify any musculoskeletal imbalances within your body.  A knowledgeable personal trainer having a sound background of anatomy, kinesiology and biomechanics can strengthen and stretch the appropriate muscles in order to rebalance and reduce postural deviations.   Having good alignment will enable you to live a pain-free, mobile and functional life.