Exercise and arthritis. Exercise and the back.
Some of the positive benefits from participating in aerobic activity have already been addressed. However, an individual's ability to participate in many aerobic activities may be contingent on the ability to maintain a neutral or a stabilized spine. For example, the individual for whom jogging has been painful may be able to jog after he or she has learned trunk stabilization and is able to keep the spine in his or her pain-free position. Although Williams contended that jogging was an inappropriate activity for the individual with a low-back problem, contrary to this notion, White believes that jogging is more apt to protect a person from low-back pain than to cause it. Although no association was found between mileage run and osteoarthritis, jogging is not for all individuals who present with LBP or related arthritic conditions. Moreover, poor biomechanics in running can exacerbate existing low-back problems as well as bring about new ones as compensatory adaptations are made. For example, poor running technique might include excessive forward lean; this must be counterbalanced by contraction of the back extensors, which then may become overly tired or produce high intersegmental forces on the discs. We advocate an upright posture with minimal forward lean. The biomechanics of running also are most important from the perspective of shock absorption. Factors to consider in addition to running within the neutral spine excursion include cushioning footstrike by "giving" at the ankle, knee, and hip joints. In addition to good biomechanics, it would also be important to use an excellent quality training shoe and to run on a soft track as opposed to harder surfaces; hills should probably be avoided for most symptomatic individuals until they become strong. Nachemson indicates that in addition to recommending jogging for LBP, he most commonly recommends backstroke swimming, brisk walking, and stairclimbing. Bicycle riding (stationary or actual) would be another good activity; I personally endorse cross-country ski machines such as the NordicTrack (Chaska, Minnesota). The latter provides an excellent opportunity to develop aerobic conditioning without impact; moreover it incorporates the tenets of stabilization training because it is essential that the skier uses the abdominal muscles to brace and stabilize the trunk. Cross-country ski machines do, however, present certain coordination requirements to which not all individuals can adapt readily. In conclusion, although exercise is by no means a panacea, it very well may be nature's elixir that will enable some individuals beset by mechanical problems of the back to assume a more active and enjoyable life.