------------------------------------------------------------ ADVANCED BACK EXERCISES ------------------------------------------------------------ The basic exercises in the previous chapter will begin to attack the source of most backaches. But as with most plans, the body is the sum of its parts and a general exercise program to increase overall body strength and cardiovascular output from the heart and lungs goes further to enhance life and freedom from pain for a back pain patient. In addition, more difficult back and spinal exercises are also presented in this chapter. Many physicians who treat back pain sufferers recommend a comprehensive exercise program in addition to specific back and spinal conditioning. What sports and exercises are best? On the preferred end of the scale, the following sports and exercises are generally save for back pain patients. Note that for the most part these activities feature CONTINUOUS motion, LOW IMPACT potential and MILD TWISTING AND TORSION to the lower back and torso: 1) Walking briskly for twenty to thirty minutes daily. 2) Bicycling with legs fully extended and minimum crouch. Be careful lower back is straight and free from "swayback" position or excess lordosis. 3) Swimming using low stress strokes such as the crawl or sidestroke rather than butterfly stroke or diving. No sprinting. 4) Rowing if allowed by a physician. 5) Stair climbing machine. 6) Cross country ski simulation machine. Sports activities NOT generally encouraged for back pain patients normally have the potential of EXCESSIVE IMPACT OR EXCESSIVE TWISTING AND JERKING. They are also less than perfect as aerobic exercise since they are not continuous. For example, you undergo an intense burst of energy while running and batting during baseball followed by longer periods of general inactivity. The same is true of most of the other activities on the following list of activities NOT recommended: 1) Football 2) Golf 3) Tennis 4) Bowling 5) Skiing 6) Baseball 7) Basketball 8) Horseback riding 9) Soccer 10) Hockey 11) Weight lifting. As an aside you might wonder which exercise the author has chosen. An avid bicyclist, I take advantage of several hilly roads near my home for my cardiovascular workout. My circular "loop trail" is merely 5 miles long. It first takes me on a scenic winding two mile flat road which later turns up an extremely steep hill about one third of a mile long. Finally the hill returns me to another flat road and the final stretch home. The entire loop takes about twenty minutes and features a nice warmup sitting on the bicycle followed by a standing position on the bicycle as I climb the hill (almost simulating a stair stepping machine in posture) and then a pleasant "cooling off" sprint home and a return to a sitting position on the bicycle. The reason I like my personal routine is that it is a fast and intense workout. Joint stress and impact is low. Maybe not your cup of tea, but the important point is that it is convenient as a daily routine and that is the secret to making it work! Additional advanced back strengthening exercises are also available for back pain patients. Again, these should be attempted ONLY with permission of a physician. Continuing our list from the previous chapter... Exercise ten: hamstring stretch. A classic runner's warmup maneuver, but invaluable as an advanced exercise for patients who can do the earlier basic exercise group without pain. Stand facing a desk, chair or low table. Place left heel of foot on edge of table or chair. Place a hand on your extended knee for balance and concentrate on keeping your back straight. Now gradually bend your right leg so that your body begins to lower. You will feel a pulling sensation in your hamstrings. Keep the extended left leg and knee straight. Be careful to slowly do this exercise and do only a few repetitions at first so you cause only a mild stretching sensation. Overdoing this one can cause a lot of pain, so experiment slowly and carefully. Exercise eleven: chin and knee touch. Lay on your back on the floor. Extend right leg and knee straight and allow it to lie on the floor. Bring left knee up to your chest by gradually pulling it with both hands. Roll your head towards your knee and try to touch your chin to the knee. Hold for the count of five then reverse the process with the other leg. Five repetitions. Exercise twelve: scissors. Lie on your back and extend both arms out to side for balance. Lift legs and thighs into the air. Knees may be slightly bent. Slowly and deliberately using thigh muscles, "scissor" right leg past left leg and then spread legs apart. Repeat and "scissor" left leg over right leg. Your legs move from side to side as they cross over each other. Five repetitions. Exercise thirteen: hyperextension of lower back. This exercise should only be done with doctor's permission and for those who have previously built up their back strength from earlier exercises. Lay on your stomach. A small flat pillow under the abdomen may help perform this exercise. Place both hands behind back. Keep feet on floor and raise your head and upper chest off of the floor. Hold for the count of five. Do five repetitions. Exercise fourteen: crossovers. Very similar to the previous exercise, but instead of lifting upper body, first raise BOTH the right arm, head and OPPOSITE left leg. Hold for the count of five then switch to raise of left arm and right leg. Exercise fifteen: leg raise. Lay on abdomen as in last exercise, but raise and hold both legs while keeping chest and torso on the ground. You may need to shift the pillow to a position under your hips rather than under your stomach. Hold the extension for the count of five. Repeat five times. This tutorial is merely a starting point! For further information on back care and back pain, be sure to register this software ($25.00) which brings by prompt postal delivery a printed, illustrated guide to back pain written by a physician plus two software disks. From the main menu select "Print Registration Form." Or from the DOS prompt type the command ORDER. Mail to Seattle Scientific Photography (Dept. BRN), PO Box 1506, Mercer Island, WA 98040. If you cannot print the order form, send $25.00 to the above address and a short letter requesting these materials. End of chapter.