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How to Exercise Despite Pain

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Exercise is the magic elixir. It protects the heart, strengthens bones, lifts mood, increases ­energy, improves memory, boosts metabolism and prevents disease. But how can you get these benefits if your body hurts?

That is the problem for millions of Americans with chronic pain, especially knee pain or back pain. You want to exercise, but getting over that “pain hump” while you exercise is just too tough.

The irony is that pain not only makes regular exercise tougher—it also makes it more important. Why? It’s a path toward less pain and a greater ability to do everyday tasks.

To learn how to get exercise when jogging or even walking is painful, we spoke with physical therapist Marilyn Moffat, PT, DPT, PhD. She homed in on two of the biggest obstacles that keep most people away from pain-relieving exercise—knee pain and back pain. Her recommendations…

Finding Your Own Path

I’ll provide exercises below that almost everyone can do. But no single exercise is perfect for everybody, and your unique limitations and physical condition will dictate your ideal activity. Many people with chronic joint or back pain benefit from a detailed individual plan developed with a physical therapist. Ask your health-care provider for a recommendation or go to the website of the American Physical Therapy Association ­(MoveForwardPT.com), and click on “Find a PT” at the top of the page. It’s always a good idea to check with your doctor before beginning a new exercise program.

When trying these exercises, start slowly, be cautious and pay attention to doing them correctly. Important: Many people may need to build up to the “hold” times. For example, if an exercise calls for you to hold a pose for 30 seconds and that’s too hard, try doing it for 10 seconds. If even that’s too hard, just hold it as long as you can. You’ll get stronger over time.

Stop immediately if any particular movement causes sharp pain, especially in a joint area. On the other hand, muscle fatigue (even burn) should be expected, especially with strengthening exercises. It’s a good thing!

Let’s get moving…

If You Have Knee Pain

The best way to reduce knee pain is to increase the strength and flexibility in the muscles that support your knee. The key is to find exercises that permit pain-free range of motion. That means taking the load off the joint as much as possible. Walking in waist-deep ­water is a great way to do this—but not everyone has regular access to a pool. ­Alternatives…

Seated straight-leg raises build up the quadriceps, which help support the knees. What to do: Sit on the floor with your back against a wall. With one knee bent and the other leg straight out in front of you, wrap your hands around your bent leg, then slowly raise the straight leg up, keeping the knee as straight as possible—hold for 30 seconds. Then slowly lower the straight leg back to the floor. Do the exercise two or three times on each side.

Bridges strengthen the hamstrings and quadriceps (key knee muscles), as well as the glutes and both the front and back of your body’s core. What to do: Lie on your back with your knees bent, and your feet and upper arms on the floor. Bend your elbows to a 90-­degree angle, with your fingers pointing to the ceiling. Lift your glutes (butt muscles) off the floor, then straighten one leg out in the air at the level of the opposite knee and hold for 30 seconds. Bend the knee down, put your foot back on the floor and lower your butt. Alternate legs. Do this exercise two or three times per leg.

If You Have Back Pain

People with spinal stenosis (narrowing of the spaces within the spine) or other degenerative changes in the low back have a hard time with many exercises. Even walking can be difficult with spinal stenosis because each step slightly extends the spine, which narrows the spinal canal, exacerbating the pain.

What helps: Increasing flexibility and core strength. Yoga planks with the spine straight or slightly rounded are especially beneficial—they strengthen the core muscles that support the back as well as the arm and leg muscles. Pay attention to good form.

Basic front plank. Start on your hands and knees with your hands directly under your shoulders and your knees directly under your hips. Straighten one leg all the way back, then the other leg, and you should be in perfect position. (If weight bearing on straight arms is too difficult, do a plank on your forearms.) Tuck your chin in so that your neck is straight and you are looking at the floor. Your spine should be in a straight line and not arched. Maintain as straight a line as is comfortable from your head through to your ankles. Hold for 30 seconds. Do two or three times.

Side plank also strengthens the core muscles and the arms and legs. Start by ­lying on your right side and with your right hand directly under your right shoulder. Ideally your feet should be stacked one on top of the ­other, but it’s fine to start with the bottom knee bent. Lift your hips off the floor, and keep a straight line from your head through your shoulder, hips and feet. As you lift your hips, push your right hand into the floor. (Again, if weight bearing on a straight arm is too difficult, do the side plank on your forearm.) Hold for 30 seconds. Alternate sides. Do two or three times on each side.

Aerobic Fitness for Anyone with Pain

Whether you have pain in your knees or back (or hips or somewhere else), getting aerobic activity to improve your circulation and protect your heart can be challenging. But it’s vital! Here are ways to do it…

Recumbent exercise bikes (the kind where you are seated against a backrest) and seated stepper machines allow you to build your aerobic capacity. Being seated while doing aerobic exercise usually is easier for your back and reduces the forces on your knees that would occur if you were using a treadmill. The seated stepper, which resembles a recumbent elliptical machine, engages your arms as well as your legs. Many gyms have these machines.

What about walking? It’s great if you can do it comfortably. Tip: To absorb impact, wear sneakers that have good cushioned bottoms, add gel inserts into the sneakers and wear padded socks.

When walking on a treadmill, use the handrails for support and to off-load some of the force of the body weight on your back and knees.

When walking outside, choose school tracks or nature paths if ­possible—they’re a little easier than paved sidewalks and roads—and you might consider walking poles. They help to absorb some impact, engage your upper body, help intensify your workout and improve stability. They are available at sporting-goods stores and online. Be sure to use two poles for the best balance and posture.

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Source: Marilyn ­Moffat, PT, DPT, PhD, a practicing physical therapist and professor of physical therapy at New York University, New York City. She is author of two books for the lay audience and four professional books in the field. Steinhardt.nyu.edu/faculty/Marilyn_Moffat Date: September 15, 2018 Publication: Bottom Line Personal
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