The Wellness Column
by Martin Sanford, DC

Caveats for Exercise


1. While there is a common belief that exercise sessions should be      performed at least three times per week, it appears low-back exercises have the most beneficial effect when performed daily.


2. The “no pain, no gain” axiom does not apply when exercising the low back in pained individuals, particularly when applied to weight training.


3. General exercise programs that combine cardiovascular components

(like walking) with specific low-back exercises have been shown to be more effective in both rehabilitation and for injury prevention.


4. Diurnal variation in the fluid level of the intervertebral discs (discs are more hydrated early in the morning after rising from bed) changes the stresses on the discs throughout the day. Specifically, they are highest following bed rest and diminish over the subsequent few hours. It would be very unwise to perform full range spine motion while under load shortly after rising from bed.


5. Low-back exercises performed for maintenance of health need not emphasize strength; rather, more repetitions of less demanding exercises will assist in the enhancement of endurance and strength. There is no doubt that back injury can occur during seemingly low-level demands (such as picking up a pencil) and that the risk of injury from motor control error can occur. While it appears that the chance of motor control errors, which can result in inappropriate muscle forces, increases with fatigue, there is also evidence documenting the changes in passive tissue loading with fatiguing lifting. Given that endurance has more protective value than strength, strength gains should not be overemphasized at the expense of endurance.


6. There is no such thing as an ideal set of exercises for all individuals. An individual’s training objectives must be identified (be they rehabilitation specifically to reduce the
risk of injury, optimize general health and fitness, or maximize athletic performance), and the most appropriate exercises chosen. While science cannot evaluate the optimal exercises for each situation, the combination of science and clinical experiential “wisdom” must be utilized to enhance low-back health.


7. Be patient and stick with the program. Increased function and pain reduction may not occur for three months.