Research (Journal of Strength and Conditioning Research, April 2013) has indicated that performing static stretches before your workout may inhibit explosive and strength performance.  Instead, dynamic or ballistic stretches are recommended before your workout in order to lessen injury risk.  Static stretches, in which you hold a stretch for a duration (e.g., 15 to 30s), may actually reduce your performance (i.e., reduce speed and strength) when performed before your workout or athletic event.  Dynamic stretches, on the other hand, serve to warmup the muscle tissues via quick extensibility stretches without increasing the risk of injury during a workout.  In addition, dynamic stretches elevate heart rate, enhance blood flow and stimulate nerve conduction impulse.  Examples of dynamic stretches (think plyometric movements) include jump squats and explosive pushups for the lower and upper body, respectively.  An example of a recommended warmup for your hamstrings would be a gentle bouncing bend-and- reach while standing or sitting.  This should be followed by the performance of one or more light sets of your beginning exercise such as Romanian deadlifts.  

BOTTOM LINE:  Perform dynamic stretches before your workout to warmup muscle tendons.  Perform static stretches after your workout to cool down muscle tissues.  

     Knee pain is the most common complaint for people, especially among overweight and/or older adults.  In the case of overweight people, the increased load-bearing that's needed for the knee joint can cause knee pain.  In the case of older people, knee pain can be a result of osteoarthritis, a degenerative joint disease.   In either case, the result is usually inflammation caused by joint aggravation.  Inflammation is what causes joint pain.  Swollen tissue presses against nerve endings, causing the sensation of pain.  Accompanying the inflammation is stiffness and local tenderness at the joint.  
     The management of acute or chronic knee pain entails the acronym PRICE:

• P= Protect the knee (use padding to prevent further injury)
• R= Rest the knee (expedites the healing process)
• I= Ice the knee  (reduces swelling if applied as soon as possible)
• C=Compress the knee joint (use a brace or wrap to reduce swelling and to keep the joint in alignment)
• E=Elevate the knee joint (reduces swelling by propping the joint on a pillow or foam roller) 
  

     Over-the-counter (OTC) medications can be used to manage knee inflammation and pain (e.g., Aleve, Advil, Motrin).   In addition, Tylenol can be used to control knee pain although it is not as effective in reducing inflammation.  
     Set up an appointment with a doctor or orthopedist if PRICE and OTC medications fail to lessen knee pain in a week.  X-rays and/or CT scans (to detect possible bone fracture or dislocation) or an MRI (to detect possible ligament or tendon injury) may be warranted depending on the nature of the pain and range of motion of the knee joint.   In addition, fluid may be drained from the bursae, fluid-filled sacs which cushion the joint, to lessen inflammation and joint pain. 
     Knee pain as a result of osteoarthritis (OA) is a chronic condition since inflammation is persistent due to cartilage degeneration.  Activity usually increases knee pain and prolonged sitting results in stiffness.  Treatment entails either taking OTC or prescription medications.  Joint injections of hyaluronic acid (e.g., Synvisc-One) can relieve chronic pain from OA.  Severe cases of OA may require narcotic pain medications or knee joint replacement.  
     After treatment, you can prevent further pain by:

• Losing bodyweight (reduces force impact on the knee joint)
• Periodic stretching (reduces tendon tightness)
• Water exercise (buoyancy reduces force impact on the knee joint)
• Wear a brace , compression or knee pads when active

     Many people who exercise may still incur injuries or lack stamina even though they are active.  For instance, a runner may pull his or her iliotibial band (ITB) when running because of weakened core muscles or a weight lifter may lack the endurance to run up a series of steps without feeling quite winded.  Avid bicyclists may lose bone density due to a lack of impact and resistance on the bone tissue.  How can those who perform certain exercises (e.g., running, swimming, biking, weight lifting, etc.) reduce their risk of injury while increasing their overall performance?   The solution is to perform well-rounded exercise programs which encompass resistance training, cardiovascular training as well as flexibility.  
     A comprehensive training program is necessary to enable your body to adapt and withstand multiple stimuli in order for it to perform at its peak level.  Thus, runners should perform weight training exercises (i.e., overhead dumbbell presses, squats, lunges, leg extensions, etc.) to strengthen upper body and core muscles and to reduce injury risk.  Weight lifters should run, bike and/or swim to increase their endurance and cardiorespiratory capacity.  Cyclists should perform weightlifting exercises to maintain bone mass.  All active people should perform stretching exercises to increase joint, muscle and tendon flexibility.  Yoga can benefit any active person.  No one particular exercise should predominate your regime.  Instead, complimentary exercises are necessary in order to ensure moderation and balance.          
     
      

     According to a new Australian study of almost a quarter million healthy adults, sitting too much increases the risk of premature death (Archives of Internal Medicine).  The greatest risk was for those who sat for at least eleven hours daily--they were 40% more likely to die within 3 years than those who sat less than four hours daily.  Prolonged sitting can have adverse effects on health including an increased risk of hypertension, heart attack, obesity, chronic kidney disease, some cancers, decreased HDL (the good cholesterol), increased triglycerides, and elevated blood sugar (which may increase the risk of type-2 diabetes).  

BOTTOM LINE:  Take a short break (just a few minutes) every hour while sitting to get up, stretch, and take a short walk to get the blood circulating.  By doing this, you can literally increase your life expectancy.

    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.

    Nearly 80% of adults will experience some sort of back pain in their lifetime.  Back pain is a phenomenon and is therefore not clearly understood because any number of underlying factors may be involved (e.g., unhealthy spinal posture, lifting too much weight, lifting while twisting, sedentary lifestyle, being overweight, etc.).   Here's the vicious cycle:  poor posture may contribute to back pain which in turn may worsen poor posture.  Once your back starts hurting, the vicious cycle begins with the end result being worse posture than before back pain.  By the way, the invention of the computer certainly has not helped in terms of improving human posture.  
    Poor posture is exhibited by misalignment of the cervical, thoracic and/or lumbar curvatures of the spine (e.g., rounded shoulders, protruding buttocks and abdomen, excessive arch of the lower back).  This imbalance of spinal alignment may cause associated ligament and muscle strain as well as compressed nerves.  Poor posture over the long-term may increase wear on joint surfaces, contributing to the development of osteoarthritis.  Thus, to reduce back pain it makes sense to readjust the spinal curvatures into balanced alignment so as to lessen muscular strain and nerve compression.    
          
MYTH: 

"I shouldn't do any physical activity if my back hurts"

FACT: 

The above statement is a myth because physical activity can reduce back pain by increasing muscular strength and spinal flexibility.  In fact, it may be due to muscular weakness that is a root cause of back pain.   If necessary, follow your doctor's recommendation to get one or two days of bed rest only if the pain is debilitating.  In general, acute and chronic pain require up to 2 days and 2 weeks of rest, respectively.  Be sure to get up and about soon afterward since lying in bed for an extended period of time may actually exacerbate back pain due to increased stiffness.  Remember, staying in bed and relaxing is NOT the best cure or treatment for back pain--the sooner you get moving, the better.

SOME BACK PAIN PREVENTION TIPS:

• Maintain proper posture by sitting on a stability ball while at your desk (it's hard to slump while sitting on the ball)
• Perform core stability exercises daily (e.g., ball hyperextensions, glute kickbacks, supine ball hamstring curls, ball abdominal crunches)
  
• Take a Yoga and/or Pilates class to increase muscular flexibility, particularly at the spine and hamstrings
• Stretch your muscles daily (esp. hamstring stretch)
• Decrease your bodyweight
• Stop smoking
• Wear comfortable footwear and avoid high-heels and worn-out shoes
• Walk with your chest out, abdomen in, and buttocks tucked in
• Practice abdominal contractions throughout the day
• Shift your bodyweight periodically from one foot to the other when standing for prolonged durations or simply rest one foot on a stool
• Avoid sitting for long periods of time  (this is a big one!)
• Put a small lumbar roll against your lower back for additional support while sitting
• Sleep with a pillow under your waist while on your side
• Avoid wearing a heavy backpack or shoulder bag for long periods of time

TREATMENT OPTIONS FOR BACK PAIN:

• Thermotherapy  (e.g., ice pack for acute injury to lessen inflammation, heat pad or hot bath for chronic injury to relax tight muscles)
• Cryokinetics (e.g., ice pack immediately followed by knee-to-chest stretch)
• Acupressure
• Acupuncture
• Nerve stimulation (e.g., transcutaneous electrical nerve stimulation (TENS) may block incoming pain signals)
• Chiropractor (e.g., manual manipulation, spinal realignment)
• Massage (esp. deep-tissue)
• Psychologist  (cognitive behavioral therapy to target how one thinks about physical activity)
• Biofeedback  (train your brain to control your response to pain)
• Spinal injection (e.g., corticosteroid helps relieve inflammation)
• Flexibility (e.g., knee-to-chest stretch, cat-dog stretch, child's pose)
• Exercise  (e.g., swimming, walking, yoga)--bed rest is the worst thing you can do and may make your back pain even worse!!
• Sleep with plenty of pillows  (i.e., when on your back:  position pillow under your knees; when on your side:  position a pillow between your knees and another one under your waist)
• Physical therapy (i.e., learn how to properly sit, stand and move without causing back strain; learn core exercises)
• Medication(s):   NSAIDs, acetaminophen (e.g., Tylenol)
• Surgery:  should ALWAYS be the last option  (e.g., discectomy to remove disc material to lessen nerve pain caused by bulging disc; spinal fusion to help stabilize the spine)

Here are the recommended guidelines for training the back:

• F:  resistance training:  2 to 3 days/wk; cardio training:  3 to 5 days/wk 

• I:  resistance training:  less than 80% 1-RM; cardio training:  40 to 65% HRR

• T:  resistance training:  15 to 30 mins; cardio training:  20 to 40 mins

• T:  resistance training:  perform core isometric exercises (e.g., lumbar extension); cardio training:  walking, swimming, cycling

• STRETCHING:  perform gentle lumbar flexion stretches

    Despite the lack of knowledge regarding the etiology of back pain, it is possible to prevent or at least reduce the onset of back pain.  The bottom line is you should make every effort to keep your spine limber and your muscles strong and flexible in order to reduce spinal curvature misalignment and the resulting back pain.