Aerobic Exercise and Back Pain

Eight of every 10 people will experience low back pain at some point during their lifetime.  Most low back comes in waves.  Acute flare ups are interspersed with periods with of very little or no pain.  You can manage how often and how severe each episode is by performing regular exercise.  Many different types of exercise are beneficial for people with persistent back pain.  The overall health benefits of aerobic exercise are unquestionable.  However, you may be unsure how aerobic exercise can help your back pain.  This article discusses 3 types of aerobic exercise that can help you manage your back pain.

What is Aerobic Exercise?

By definition, aerobic exercise means “with oxygen.” It is typically performed at low to moderate intensities over an extended period of time.  Your breathing and heart rate will increase as you exercise. This helps keep your heart, lungs, and circulatory system healthy.  Aerobic exercise is any type of cardiovascular conditioning.  It can include activities like brisk walking, swimming, running, or cycling. You probably know it as “cardio.”

physical activity exercise guidelines

The American College of Sports Medicine (ACSM) and the Center for Disease Control (CDC) recommends adults engage in at least 150 minutes of moderate physical activity each week.  We usually recommend 30 minutes of aerobic exercise 5 days per week.  The 30 minutes each day can be broken up into 2 to 3 shorter sessions that total 30 minutes.  Not only will this improve your health and fitness, it will also help you manage your back pain.

Walking for Back Pain

The most commonly prescribed form of aerobic exercise for people with back pain is walking.  It is human nature to walk.  Yet, most of us spend an excessive amount of time sitting versus walking.  Sitting increases stress to the discs in our low back.  Walking helps nourish and strengthen the discs, joints, and muscles of the spine.

walking for low back pain

A 2015 study published in the journal Pain compared the benefits of 3 different exercise programs in adults with at least 12 weeks of back pain.  Participants performed a supervised walking program, group fitness classes, or supervised physical therapy.  After one year, all 3 groups showed large improvements in pain, disability, and their fear of movement.  The participants who performed the walking program showed the best adherence and this form of treatment was the least costly.

This study helps establish guidelines for starting your walking program.  You can begin your walking program with as little as three 10-minute walks per week.  Start small and slowly progress your walking distances.  It is helpful to use a step counter or tracker.  Keeping a diary or log will allow you to track your progress and stay motivated.   Your goal is to meet the 150 minutes per week recommended by the ACSM and CDC.  How you structure the program is ultimately up to you.

Cycling for Back Pain

Walking is not the most enjoyable form of exercise for everyone.  You may prefer cycling on the road, in doors, or in nature.  Just like walking, cycling is a proven form of exercise that helps people with persistent low back pain.  Older adults often prefer cycling but this form of exercise can be beneficial for people of all ages.

cycling for low back pain

A 2003 study published in the Archives of Physical Medicine and Rehabilitation showed benefits to cycling in older adults with persistent back pain.  Participants performed 12 weeks of cycling 3 times per week.  After 12 weeks, physical functioning, mental health, and pain levels improved by 8% to 14%.

Another larger study published in Spine compared stationary cycling to Pilates in adults of all ages with persistent back pain.  Pilates is another proven form of exercise for people with low back pain.  Stationary cycling included slower steady state intervals mixed with hills and sprints.  Both groups showed clinically meaningful improvements in pain and disability after 8 weeks.  Participants performing the Pilates exercise did slightly better.  However, these results show that cycling 150 minutes per week is a viable strategy for people with persistent low back pain.

Running and Back Pain

Running gets a bad rap in many regards.  Yes, running increases some stress to the structures of your spine.  However, this does not imply that running is harmful to your back.  In fact, some studies show running is associated with a reduced incidence of low back pain.

aerobic exercise back pain

A 2020 review of back pain in runners showed very low prevalence and incidence compared to the general population.  This suggests running may be protective against back pain.  Further research is needed to prove this claim.  However, this study does show heavier runners, taller runners, and runners with poor flexibility are at greater risk for developing low back pain.

If you have never run before and you are bothered by back pain, we do not suggest you start.  Instead, start with a walking, swimming, or cycling program,.  However, if you are an experienced runner with back pain, keep running.  The benefits far outweigh the risks in most instances.  You just might need to supplement your running with other forms of exercise such as resistance training, stretching, and core exercise.

Start Your Aerobic Exercise Today

The physical and mental health benefits of aerobic exercise are unquestionable.  And many forms of aerobic exercise have also been proven to be effective at decreasing back pain.  The specific type of aerobic exercise is less important than the amount, frequency, and consistency.  Choose the form of exercise that resonates most with you.  Aim for the guideline recommended total of 150 minutes per week.  You can achieve this spread out over 3 to 5 days or more per week.  Call your physical therapist if you need help getting started.

Pilates Exercise for Back Pain

Are you looking for the right type of exercise to help your aching back?  There are many kinds of exercise that are helpful for people with ongoing back pain.  However, there is no one universal form of exercise that is best for everyone.  Pilates is one form of exercise that is very beneficial for many people with persistent back pain.  Pilates is a form of mind-body exercise that strengthens your core while also improving posture and flexibility. This low-impact approach may be a good option for you if your back pain has been aggravated by other forms of exercise.

Pilates Basics

Pilates is based on 6 basic principles: centering, concentration, control, precision, fluidity, and diaphragmatic breathing.   Each exercise is performed with isometric contraction of the transversus abdominis, perineal, gluteal, and multifidus muscles during diaphragmatic breathing.  This is known as the “Powerhouse”.  Pilates exercise is adapted to your abilities.  Exercises are gradually increased in difficulty as you become more comfortable and confident.  Pilates is now being prescribed for many people with back pain who have failed other forms of exercise.

Pilates for Back Pain: A Proven Approach

A 2014 study published in the Physical Therapy Journal looked at the effects of the Pilates Method in people with low back pain for more than 3 months.  Half the participants performed mat-based Pilates and the other half performed equipment-based Pilates using the reformer.   Sessions were lead by a physical therapist who was also a certified Pilates instructor.  After 6 weeks, all participants reported less pain, improved disability, and less fear of movement.  Participants performing the equipment-based exercise reported slightly less disability than those performing mat-based exercise.   In conclusion, both types of Pilates exercise can help people with back pain.

Your “Powerhouse”

Pilates begins with activating your “powerhouse” or core.  This is the foundational exercise for the Pilates Method.  To practice, begin on your back with your hips and knees bent.  Place your hands on your abdomen.  Concentrate on each breath.  Breathing occurs slowly through the rising and lowering of your abdomen.  Next, gently pull your belly button in and down towards your pelvis.  This activates your transverse abdominis and pelvic floor muscles. Be sure to maintain your diaphragmatic breathing as you activate your ‘”powerhouse”.

Modified One Hundreds

Lay on your back with your knees bent and arms to your side.  First activate your “powerhouse”.  Next, raise your arms from the mat.  Slowly raise your head and then shoulders slightly off the mat.  Hold this position and perform 5 arm movements for each breath in and each breath out.  Then, lower yourself back down to the starting position.  Perform 4 to 10 controlled repetitions.  Each repetition includes 10 arm movements up and down (5 on the breath in and 5 on the breath out).  The goal is to perform 10 repetitions for a total of 100 arm movements.

One Leg Circle

Lay on your back with one knee bent and the other straight.  First activate your “powerhouse”. Next, raise your straight leg up until you feel a stretch in the back of your thigh.  Slowly perform 5 clockwise circles with your leg.  Then perform 5 counterclockwise circles.  Lower your leg back down to the starting position.  Repeat another repetition on the opposite side.  Perform 4 to 10 controlled repetitions.

One Leg Kick

Lay on your stomach.  First activate your “powerhouse”.  Then prop yourself up onto your elbows.  Next, bend one knee until you feel a stretch in the front of your thigh.  You can perform 1 or 2 controlled kicks with each leg.  Alternate legs while you maintain activation of your “powerhouse”.  Perform 4 to 10 controlled repetitions on each side.

Side Kick

Lay on one side your both legs straight.  Begin with your feet slightly in front of your body.  Activate your “powerhouse”.  Raise your top leg slightly.  With your knee straight and toes pointed up, raise your leg in front of you.  You can perform 1 or 2 controlled kicks in this position.  Next, move your leg behind you as your point your toes down.  Perform 4 to 10 controlled repetitions on each side.

How to Get Started with Pilates

If you have been struggling with back pain for a while, Pilates may be right for you.  As with any new exercise program it is best to have your physical therapist examine you before starting.  You can also visit a local certified Pilates instructor at Pyour Core or Black Sheep Studios. This way you can avoid any unnecessary increase in pain.  If you would like our help, call to schedule an appointment.  We want to help you move pain free.

McKenzie Exercises for Back Pain

McKenzie exercises are effective for reducing your back pain especially if it has been traveling down your leg.  People with back pain lasting more than 3 months are good candidates for McKenzie exercises.  Based on the latest research, the McKenzie Method of treating back pain is equally effective to other approaches.  This includes manual therapy and stabilization or strengthening exercise.  The key is to identify the right exercises for you to perform.  There is no one-size-fits-all approach for managing back pain.

What are McKenzie Exercises?

Actually there are no specific exercises which are unique to the McKenzie Method.  Robin McKenzie was a physical therapist from New Zealand who popularized his approach to assessing people with back pain.  His approach is more about how to assess a person with back pain, not special exercises.  The McKenzie Method of assessment and treatment is based on several key principles.  These are the principles your physical therapist utilizes when evaluating you on your first day.  Here is a very brief explanation of 3 of those principles:

  1. End-range movements. Exercises are performed through a full range of motion.  This may include exercising with some back pain.  The key is that each movement is performed through an increasing range of motion provided the appropriate response is occurring (see principle #3 below).
  2. Repeated movements. Once the correct exercise is identified, it is repeated often.  Multiple sets of 10 or more repetitions are performed several times per day.  Sometimes we recommend the exercise be performed every hour during the day. Most exercises are performed in and out of the range of movement instead of holding each stretch.
  3. Centralization. This refers to the location of pain you experience during and after the exercise.  In simple terms, you want your pain to decrease in your leg even if it increases in your back.  Pain traveling down your leg is a sign of a longer recovery.  You want the pain out of your leg as soon as possible.  Identifying the right exercise to alleviate your leg pain first is the responsibility of your physical therapist.

McKenzie exercises

Which Exercises are Right for You?

The 3 principles described above, help your physical therapist identify the right exercise approach for you.  The most important principle is that of centralization.  It is very important that your leg pain does not worsen during or immediately after performing your exercises.  Sometimes, your back pain gets a little worse as your leg pain gets better.  This is a sign of improvement.  However, if your back feels better and your leg feels worse, you are not on the right track.  Below are several common exercises we prescribe to help alleviate leg and back pain.

Flexion Exercises

If sitting or bending forward alleviates your pain, flexion exercises might be best for you.  Your physical therapist will conduct an examination to confirm whether or not these are the right exercises.  For flexion in sitting, position yourself close to the edge of chair.  Spread your knees apart.  Relax your back and slowly bend forward towards the floor.  Do not bounce or force the movement.  With each repetition, try to move closer and closer to the floor.  If you can touch the floor easily, try to reach behind you.  Remember, you do not want pain to increase or spread down your leg.  Perform 10 repetitions several times per day.

Extension Exercises

If walking or leaning backwards alleviates your pain, extension exercise might be best for you.  Your physical therapist will conduct an examination to confirm whether or not these are the right exercises.  The most effective extension exercise is performed in the lying position.  Your arms do all the work.  Your back remains relaxed.  With each repetition, try to move further and further.  Remember, you do not want pain to increase or spread down your leg.  Pain in your back is okay. Perform 10 repetitions several times per day.

Shift Correction Exercises


If you look or feel crooked, you may have a lateral shift.  Usually, people shift their shoulders away from the side of their back pain.  It is important to correct any shift before commencing with extension or flexion exercises.  This can be tricky.  It typically requires careful examination by your physical therapist.  The standing side glide is one exercise that is effective for correcting a shifted posture.  Start very gently and remember you do not want pain traveling down your leg.  Start with 10 repetitions several times per day.

Keys to Success with McKenzie Exercises

If you are struggling with back and leg pain, try these exercises.  Do any of these exercises feel good?  More importantly, do any alleviate or decrease your leg pain.  If so, continue with them.  Any movement or exercise which causes pain to spread down your leg is not right for you.  It is best to have your physical therapist examine you before starting.  This way you can avoid any unnecessary increase in pain.  If you would like some help, call your physical therapist to schedule an appointment.  We are here to help you move pain free.

5 Simple Low Back Stretches

Low back pain is one of the most common reasons people visit their doctor.  It is also a common reason to miss work.  More than 80% of people will experience back pain at some point in their lifetime.  A large majority will recover well in a few weeks.  Only about 10% will experience ongoing or persistent back pain.  Whether you experience ongoing or intermittent back pain, doing the right back stretches will help.

Frustrated with Your Back Pain

The truth is, your back pain most likely comes in waves.  You may experience low back pain for a few weeks, and then you fully recover.  This cycle repeats over time. However, with each new episode the severity of your back pain usually worsens. The duration of each episode becomes longer as well.  It becomes harder and harder to recover.  You become frustrated.  Some people seek the elusive magic treatment to make all their back pain go away forever.  Not finding it only adds to your frustration.

Your back pain does not have to be debilitating.  And instead of your back pain controlling you, you can control your back pain.  Exercise is a proven way to decrease your chances of having low back pain.  It is also a proven way to treat your already painful back.  There are many different forms of exercise that are helpful.  These include strengthening exercise, stretching, yoga, Pilates, and aerobics. This article focuses on simple low back stretches you can do to prevent and treat your back pain.

Feel Better with Low Back Stretches

knee to chest

Exercise has a powerful protective effect on low back pain.  Exercise performed consistently over time will reduce your chances of experiencing back pain.  It will not totally eliminate your risk.  However, when you do experience an episode of back pain, you will recover easier and quicker.  Large studies show strengthening exercises are the best for reducing your chances of back pain.  However, stretching exercises are also proven to be helpful.  The best approach is to include both strengthening and stretching exercises in a regular program.

Low Back Stretches: The Right Stretches for You

Low back stretches should be simple and easy to perform anywhere.  We recommend daily stretching exercises each morning.  Stretching takes no more than 10-15 minutes.  This is a great way to start your day.  You will feel more flexible, awake, clear-minded, and energetic.  The 5 stretches that follow are only a few examples.  There are many more stretches you can do.  The key is to find the vital few that work best for you.  Some trial and error is needed.  If you need some help, contact your physical therapist.

Pelvic Tilt

The pelvic tilt is one of the most basic range of motion exercises you can do.  It helps improve mobility of each individual joint in your lumbar spine and pelvis. You start on your back with your knees bent.  Place your hands on your pelvis.  Gently tilt your pelvis towards your head.  At the same time flatten your low back into the floor or bed.  You will feel your abdominal muscles gently tighten.  This is a good thing.  Next, tilt your pelvis in the opposite direction.  Now your back will arch away from the floor or bed.  Start with small and slow movements.  If you experience pain in either direction, minimize how far you move at first.  Perform 10 to 20 slow repetitions each day.

Double Knees to Chest

Knee to chest exercises lead to flexion of your spine.  This opens up your joints and vertebrae.  Many people with spinal stenosis benefit from flexion exercises.   You start on your back with your knees bent.  Raise your feet off the floor and hug your knees to your chest.  Hold this position for 5 seconds.  Perform 10 to 20 repetitions each day.  Avoid holding your breath.  Do not continue this exercise if you experience pain running down your leg.  If this is the case, try the press up exercise below or contact your physical therapist for more guidance.

Lower Trunk Rotations

Most people really like this stretch.  It is relaxing and easy to perform.  You start on your back with your knees bent.  Keep your feet and knees together.  Gently rock your legs from one side to the other.  Your hips can come up but keep your shoulders flat on the floor.  Hold each stretch for 3 to 5 seconds.  Perform 10 to 20 repetitions to each side.   To increase the stretch, hold your feet up off the floor.  This also causes the stretch to move up a little higher into your thoracic spine.  It is also more challenging.

Press Ups

Press ups help many people with sciatica or pain from disc problems.  Start lying on your stomach with your hands in a push-up position.  Relax your hips and legs.  Push your upper body up from the floor.  Keep your low back relaxed.  Your arms should be doing all the work.  Hold this position for 2 to 3 seconds.  Exhale fully, and then return to the starting position.  Perform 10 stretches each day. Do not continue this exercise if you experience pain running down your leg.  If this is the case, try the knee to chest exercise above or contact your physical therapist for more guidance.

Child’s Pose

There are many different modifications and variations to this exercise.  Start on your hands and knees.  Sit back onto your heels with your hands out in front.  Relax your back and exhale.  Hold the stretch for at least 5 seconds. You can emphasize stretching one side of your  back by moving your hands to the opposite side.  Do whatever feels best.  Perform 10 stretches each day.

Begin Your Low Back Stretches Today

Feel good

Low back stretches are best if they become part of your daily routine.  The 5 stretches included here can be modified to meet your needs.  There are also many other stretches that have helped many thousands of people with back pain.  The keys are to find what works for you and be consistent with performing them.  Don’t wait for your back pain to get out of control.  Start stretching while you are feeling good.  Don’t you want to feel great, all the time?  If you need help getting started, contact your physical therapist.  We want to help you move without pain.

Pool Exercise for Arthritis: Tips to Get You Started

Arthritis leads to more trouble walking and climbing stairs than any other muscle, joint, or bone problem.  Treatment cannot “cure” arthritis. However, many treatments can slow the progression, reduce pain, and improve your quality of life.  Exercise is one of the most researched and proven treatments for people suffering with arthritis pain.  But what type of exercise is best for you?  This article focuses on the benefits of aquatic, or pool, exercise.

Yes, exercise is medicine for people with arthritis.  Regular exercise increases your muscle strength, improves your balance, and makes you more mobile.  Increased muscle strength in people with arthritis is correlated with improved ability to walk and climb stairs.  Improved balance is correlated with reduced fall risk and greater confidence leaving your home.  All these benefits can occur by exercising in a pool.

But It Hurts to Exercise with Arthritis

Aquatic exercise may be the best option for some people with painful arthritis. It is best to seek out heated pools, typically 82 to 88 degrees.  Warm water reduces your joint pain and stiffness while exercising.  It also leads to greater muscle relaxation.  Aquatic exercise may therefore be more beneficial as an initial form of exercise for people with painful arthritis.

Arthritis exercise

Exercising in water is a gentle way to exercise your painful joints and muscles. The buoyancy of the water supports and lessens stress on your joints.  This encourages freer movement.  Water also acts as resistance to help build muscle strength.  So exercising in warm water reduces your pain, allows easier movement, and builds your muscle strength.  And don’t forget, exercising in water with friends can be very enjoyable.

Aquatic Exercise: A Proven Treatment for Arthritis

A review of 13 clinical trials including more than 1,000 people with hip and knee arthritis showed significant benefits to exercising in water.  Aquatic exercise was proven to reduce pain, and improve both disability and quality of life in people with arthritis.  However, there is one caveat to these findings.  Improvements are greatest in the short term or for about 12 weeks.  After the initial benefits have occurred with aquatic exercise, it is recommended that you also start to incorporate land exercises.

Walking in Water vs. Land

Walking in water burns more calories than walking on land.   This leads to greater weight loss compared to walking on land.  This is because the resistance of the water requires extra effort to move your body.

Compared to the walking on land, joint forces are reduced by 36–55% when exercising in water.  In fact, some forces during weight bearing exercises are reduced by more than your body weight when performed in water.  This creates an ideal environment to improve your strength, endurance, and walking ability without loading your painful joints.

Guidelines for Starting Aquatic Exercise

You will feel really good moving in the warm water.  However, it’s possible to over-exercise, become fatigued and aggravate your joint pain.  You may not realize this until you get out of the water.  Therefore, it is best for you to start slow.  The Arthritis Foundation has put out guidelines for exercising in water.  Follow these and you will minimize the risk of any painful flare ups.

  1. Start slowly and don’t overdo it.
  2. Submerge your body part being exercised.
  3. Move your body part slowly and gently.
  4. Begin and end with some really easy exercises.
  5. Move through your complete range of motion, but do not force movement. Stop if you experience any sudden or increased pain.
  6. Do about 8 repetitions of each exercise as tolerated. You can do 2 to 3 sets of each exercise.
  7. Pain that lasts for more than 2 to 3 hours after exercise may indicate overuse. Cut back next time.
  8. Exercising in excessively warm water (more than 98 degrees) can lead to weakness and exhaustion.
  9. If you have severe joint damage or a recent joint replacement you should check with their doctor before starting.

Pool exercise

Here are a few more important considerations:

  1. Water shoes will help you with traction on the pool floor.
  2. Water level can be waist or chest high.
  3. Use a Styrofoam noodle or floatation device to keep you afloat in deeper water.
  4. Slower movements in the water provide less resistance than faster movements.
  5. You can use webbed water gloves, Styrofoam weights, inflated balls, or kickboards for increased resistance.
  6. You will not notice that you sweat with pool exercises, but it is still very important to drink plenty of water.

Want More Help Getting Started

If you are ready to get started, try some or all of these 10 exercises in the pool.  Also, the Arthritis Foundation sponsors pool exercise classes.  These are great for people looking for some help at first.  Or, you may be looking for a more individualized program.  Your physical therapist will perform an examination to help you identify your weak points.  Then, you and your physical therapist can design the best pool exercises specific to your needs.  Give us a call if you would like help getting started.

Arthritis: Aerobic Exercise to the Rescue

Arthritis pain leads to reduced mobility and poor physical fitness in older adults.  Pain from arthritis starts a viscous cycle.  This includes reduced physical activity, depression, more pain, and ultimately worsening health and quality of life.  Does this sound painfully familiar?

People with chronic conditions, such as arthritis, should perform regular aerobic exercise.  We do not recommend excessive rest and relaxation.  Regular exercise leads to improved functional abilities that are important to perform your daily activities like shopping and taking care of your home.

To maintain aerobic fitness and weight control, the American College of Sports Medicine recommends you perform aerobic exercise 3 to 5 days a week for 20 to 60 minutes each day.  The type of aerobic exercise you perform is completely up to you.  Also, it is important that you select the method that resonates most with you so you can stick to it.

Aerobic Exercise for Arthritis: A Proven Treatment


A large group of medical providers and researchers from around the world have developed aerobic exercise guidelines for people with knee arthritis.  Their recommendations include performing aerobic exercise along with strengthening exercise to achieve the greatest benefits.   Individualized programs or exercising in a group are both effective.

Types of Aerobic Exercise for People with Arthritis

Walking, cycling, and even running are popular forms of exercise for people with arthritis.  You can perform these forms of exercise indoors or outdoors. According to the latest research, great results are achieved with walking programs performed at least 3 days per week.  Many other people get great results from group aerobic exercise classes.  For example, zumba and step aerobics are excellent options.

Hip and knee arthritis

Individualized or Group Aerobic Exercise 

Physical therapists prescribe strengthening, stretching, balance and aerobic exercise for people with knee and hip arthritis.  If you are looking for an individually tailored program, reach out to your physical therapist.

Group classes provide social support that can help you stick to it for the long-run.  Group aerobic classes are available at many local health and fitness facilities.  We recommend Tilton Fitness, Elite Fitness, Pyour Core, Black Sheep, and others.

The Biggest Myth about Arthritis and Exercise

Have you ever been told exercise is harmful?   We sometimes hear, “exercise will only make my arthritis worse.”  Many well-educated medical professionals even make these erroneous claims.  Yes, the wrong type or amount of exercise may exacerbate your pain.  When in doubt, get some help when starting out.  In fact, well-prescribed individualized exercise will help your arthritis pain and make you a happier healthier person.

2019 review of 103 different clinical trials found 4 different types of exercise to be beneficial for people with pain from hip and knee arthritis.  These were strength training, stretching, aerobics, and mind-body exercise like yoga or tai chi.  Yoga, tai chi, and aerobic exercise are proven forms of exercise for reducing your pain.  In fact, 8 weeks of regular aerobic exercise is proven to reduce your pain from hip and knee arthritis by 50%.  This is pretty powerful.

Accept the fact that all pain is not harmful.  Some pain is expected when starting out.  However, do your best to keep it to a minimum.  Pain is your brain’s way of telling you about a potential threat.  Humans are naturally wired to be on the look out for threats to survival. However, you can decrease this perceived threat, and your pain, by truly believing that exercise is in your best interest for survival.  And this is a fact.  If you are unsure, learn more about how pain works here.

Tips to Start your Exercise Program Today


If aerobic exercise is new to you, start small.  For example, begin with 5 minute walks 3 days per week.  Then set a goal to increase the frequency of your walks up to 5 days per week.  Also, track your steps or keep a log.  Enlist family members or friends to join you and hold each other accountable.

If you need more help, sign up for a class or see your physical therapist.  Don’t wait if you are having trouble on your own. Waiting for circumstances around you to change is going to change your life for the better. Mark Twain said, “the secret to getting ahead is getting started.”

Arthritis: Treat Your Pain with Yoga and Tai Chi

Your arthritis pain can be treated with exercise.  Many forms of exercise have proven effectiveness for arthritis.  These include aerobic exercise, strength training, stretching, and balance training.  It is important for you to choose the type of exercise that resonates most with you. Then stick with it.  Mind-body exercise is another effective type of treatment for people with arthritis.  This article discusses how your mind-body connection influences your pain.  We offer suggestions so you can manage your arthritis for optimal physical and psychological health.

Mindfulness involves focusing your awareness on the present moment.  It acknowledges and non-judgmentally accepts your feelings, thoughts, and bodily sensations. Mediation is an effective practice to promote this state. Mindfulness is associated with better pain coping skills, greater physical activity and greater weight loss from exercise.  Importantly, difficulties coping with pain are a big barrier to adhering to an exercise program.   If you struggle coping with your pain, mind-body exercise, such as Yoga and Tai Chi, are excellent options for you.

Yoga for Knee Arthritis

People with knee arthritis who demonstrate higher mindfulness scores achieve greater benefits from exercise.  The most important component of mindfulness seems to be the ability to engage fully in activities in the present moment.  Yoga is a form of mind-body exercise that incorporates the acting-with-awareness facet of mindfulness.  Yoga combines mental focus with breathing techniques, stretching, and strengthening exercises.  It provides relaxation benefits and reduces your stress.  It is also a proven way to decrease your pain.

A 2016 study out of the University of Minnesota compared the effects of yoga to an aerobic and strengthening program in 84 people with knee arthritis.  After 8 weeks, both groups showed large improvements in pain, strength, anxiety, and fear of falling.  However, the people who performed yoga did slightly better in most areas.  The findings of this study support the Arthritis Foundation’s recommendation for yoga as part of a regular arthritis treatment program.

Starting Your Yoga Program

When first starting out, it is best to get some help from an instructor.  You can try taking a class once per week for a few months.  Practice at home another 2 or 3 days per week.  Then you can either continue fully on your own at home or stick with regular group classes.  Some people prefer the expert instruction and social aspect of exercising in a group.  Other people do better at home.  It’s up to you.

It’s important to select yoga poses that challenge you but are not outside of your capabilities.  Some pain is acceptable.  Remember to focus your thoughts and feelings on the present moment, not the possibility of pain.  Concentrate on each breath and your sensitivity to pain will decrease.  The following yoga poses are a great starting point for anyone with knee arthritis and new to yoga.  If needed, use a chair close by for balance.  Start with holding each pose for 5 seconds which is about 1 slow deep breath.  As you become stronger, increase how long you hold each pose (3 breaths or more).

Tai Chi for Knee Arthritis

Tai Chi is a traditional Chinese mind–body practice that combines meditation with slow, gentle, graceful movements.  It also incorporates deep breathing and relaxation similar to yoga.  Tai Chi offers physical and psychological benefits.  It results in improved quality of life for many people with arthritis. It is also less physically demanding than other forms of exercise and this makes it a very popular option.

A 2016 study in the Annals of Internal Medicine compared the benefits to Tai Chi to physical therapy treatment for people with knee arthritis.  After 12 weeks, both groups showed similarly large improvements in pain, function, walking ability, depression scores, and overall well-being.  This study suggests Tai Chi is an effective treatment option for people with arthritis.  In particular, Tai Chi is a viable option for people seeking a group exercise experience.  Those looking for more individualized exercise instruction would be better off working with a physical therapist to start.

Getting Started with Tai Chi

Similar to starting off with yoga, it is a good idea to seek out a qualified Tai Chi instructor. Stafford Township holds group sessions at the Bay Avenue community center.  Once you learn the basics you can develop a routine for home or continue with the group.  Also, physical therapists often incorporate components of Tai Chi into balance training for their patients.

Tai Chi involves moving from one pose flowing into the next.  The body remains in constant motion.  It’s low-impact, so it puts minimal stress on your muscles and joints.  This makes it safe and appealing for most people with arthritis. Tai Chi is also appealing because no special equipment is needed.   There are different styles of Tai Chi.  The video that follows shows a few basic Tai Chi poses to get you started.  Dr. Paul Lam is a physician and world-renowned expert in Tai Chi.  His programs are designed specifically for people with Arthritis.

Mind-Body Exercise for Arthritis: Take the Next Step

Arthritis pain can impact your physical and psychological well-being.  You may start to avoid long walks, limit your social outings, and become depressed over your pain. You can change this. Mind-body exercises can help you. Take a local group class to get started (Yoga or Tai Chi).  If you don’t feel like you can do it alone, call your physical therapist. The physical therapists at BSR are committed to helping you move without pain.  Exercise is the first treatment for arthritis before resorting to drugs, injections, or surgery.  We want to help you take back control of your health.

The Best Balance Exercises for Hip and Knee Arthritis

Are you having trouble walking, climbing stairs, or standing up from a chair.  Is your knee or hip pain interfering with these activities?  Are you losing muscle strength because of painful arthritis?  Most daily activities not only require muscle strength but also good standing balance. Balance problems are very common in people with arthritis.  Balance problems lead to an increased risk of falls and poor mobility. Therefore, standing balance exercises are an essential part of any exercise program to improve the lives of people with hip and knee arthritis.

A Proven Approach: The Otago Balance Exercise Program

The Otago Exercise Program (OEP) is a proven falls prevention program for older adults.  The OEP is especially beneficial for adults 75 years and older.  A 2018 clinical trial looked at the OEP to improve balance, fear of falling, and falls risk in older fallers with knee arthritis.

Older adults performed the OEP 3 times per week in their own home.  After 6 months, those who were consistent with performing their exercises showed significant improvements in balance and reduced their fear of falling.  This study provides a framework to build your own home exercise program.

The Basics of Balance Exercise

Physical therapy for balance

Balance exercises can be easily performed in your own home or under the guidance of a physical therapist. For the best results, perform balance exercises daily.  At a minimum start with 3 times per week.  These exercises will only take you about 20 minutes to perform.  This investment in time and energy is well worth the reward.  For safety, start by performing each exercise close to a wall or counter in case you need some extra support.  It is best to wear sneakers or walking shoes while exercising.

Toe and Heel Walking

Stand on your tip toes.  Walk forward 10 steps without allowing your heels to touch the floor.  Turn your body around and try walking on your heels for the same 10 steps.  Do not allow your toes to touch the floor. Perform 5 laps each on your toes and heels.   If this is not difficult for you, try walking backwards on your toes and backwards on your heels.  

Tandem Walking

You may notice that your feet have become spaced further apart when you walk.  A wide base gait pattern is one of the early signs of a balance problem.  Tandem walking corrects this.  Stand near a wall or counter.  Walk with a narrow base of support like you are on a “tight rope”.  Your heel of one foot touches the toes of your other foot with each step.  This is a challenging exercise.  It is okay to use one hand or finger on a counter for light support when first starting out.


Stand facing a wall or counter.  Space your feet about 2 inches apart with your toes pointing straight ahead.  Focus your eyes forward with your head up.  Walking with your head down and eyes on your feet is one of the early signs of a balance problem.  Take 5 small steps to the right.  Do not allow your feet to touch.  Keep your chest and shoulders up.  After 5 steps to the right, take 5 steps to the left.  Perform 5 laps right to left and left to right.


Carioca’s are a progression of the sidestepping exercise.  With this exercise, alternate front and back cross-over steps.  It is best to start holding on to a counter or wall until you become confident with this exercise.  This exercise requires adequate flexibility in your hips and legs.  If this is a problem for you, incorporate some stretching exercises into your routine.

Shuttle Walk

Walking with changes of direction can be challenging for people with balance problems.  The shuttle walk helps with this problem.  Place 4 cones or objects (shoes are fine) on the floor about 5 to 10 feet apart.  Stand at the first cone and walk to the second cone.  Stop at the second cone and then walk backwards to the first cone.  Next, walk to the third cone.  Stop.  Walk backwards to the first cone.  Finally, walk to the fourth cone.  Stop.  And walk backwards to the first cone.  Complete this cycle 5 times.

Get Started with Improving Your Balance

Arthritis pain causes you to change your activities and lifestyle.  You may start to avoid long walks, avoid stairs, or limit your social outings because of pain. The more you change or reduce your activities, the weaker your muscles become and the more your balance is affected.  You can change this.  Home strengthening exercises and balance exercises is the safest and most effective way to overcome limitations from arthritis.

If you don’t feel like you can do it alone, call your physical therapist.  The physical therapists at BSR are committed to helping you move without pain.  Exercise is the first treatment for arthritis before resorting to drugs, injections, or surgery.  We want to help you take back control of your health and quality of life.


6 Strength Training Exercises for Hip and Knee Arthritis

If you are one of millions of Americans bothered by hip or knee arthritis, this post is for you.  And if you would prefer not to rush into popping pills, having injections, or pursuing surgery, this post is really for you.  The following paragraphs are for people who want to take back control of their health and quality of life.  You may be thinking, “But there is no cure for arthritis.”  We disagree.  The Cambridge dictionary defines a cure as something that makes someone who is sick healthy again.  A cure refers to making you, a whole person, healthy again not correcting or reversing some change in your joint.  With this definition in mind, there is no better cure for your hip and knee arthritis than exercise.

There are many different types of exercise which have been proven to be helpful for arthritis.  Aerobic exercise, stretching, yoga, tai chi, aquatics, and balance training are all proven forms of exercise.  This post goes into detail about one of the most effective forms of exercise for people with hip and knee arthritis: strength training.

You may be thinking, “But my knee [or hip] hurts too much to exercise.”  Or someone may have even told you,” Exercise will make your arthritis worse.”  These claims are flat out wrong!  If you accept them as true, you are playing the victim.  Victims wait around for their lives to change.  Successful people create the changes they want in their life.  If you don’t to be a prisoner to your arthritis pain, now is the time do get moving with an exercise program.

A Proven Approach: Strength Training for Arthritis

When we look at the entire body of research done on arthritis it is clear that strength training is beneficial.  A 2019 review of 103 different clinical trials found 4 different types of exercise to be beneficial for people with hip and knee arthritis.  These were aerobics, mind-body exercise (yoga or tai chi), strength training, and stretching.  A regular strength training routine was proven to be beneficial for decreasing pain, improving function, and restoring quality of life.

In 2016, a panel of medical experts across the world reviewed the best evidence looking at exercise for people with hip arthritis. Compared to all other forms of exercise, these experts found strength training to be the best for decreasing pain, improving function, and regaining mobility.  Recommendations include performing one to three 45-minute sessions each week.  You can use exercise equipment at a local gym or fitness center.  For most people, it is more practical to start strength training at home without all the fancy equipment.  The 6 home exercises that follow focus on strengthening your core, hips, and thigh muscles.  They are a great starting point for you.

Band Knee Extension

The quadriceps muscle or “quads” on the front of your upper thigh is crucial for walking, climbing stairs, and standing up from a chair.  The quads of people with hip and knee arthritis are weaker and smaller than people without arthritis.  Weakness places additional stress through your arthritic joints.  Stronger quads reduce joint stress and decrease your pain.  Band knee extension is a great exercise to start working your quads.

Loop a resistance band around your lower leg.  Attach the other end to the leg of a chair or your bed.  Sit up nice and tall with good posture.  Extend your leg straight to activate your quads.  Do this quickly.  Once you have your knee fully extended pause 2 to 3 seconds.  Then slowly lower your leg over a 5 second period.  To review, raise the leg fast, hold 2 to 3 seconds, and then lower it back really slow.  This will give you the best results.  Perform 10 to 15 repetitions for 2 to 3 sets.

Band Knee Flexion

The hamstrings in the back of your thigh are also critical for balance and walking.  Stand to perform this exercise.  Loop a resistance band around your lower leg.  Attach the other end to the leg of a chair or your bed.  Keep a nice tall posture.  Bend your leg behind you but keep your knee directly under your hip.  All movement occurs at your knee.  No movement occurs at your hip.  Bend the leg fast, hold 2 to 3 seconds at the top, and then lower it back really slow.  Perform 10 to 15 repetitions for 2 to 3 sets.

Partial Wall Squats

Many people cringe at the word “squat”.  In fact, you may have even had another healthcare professional tell you to never squat.  Unfortunately, it is impossible to go through life without squatting.  Every time you sit down or get into your car you are squatting.   You might as well get better at it and learn to do it in a way that minimizes stress to your joints.

Stand with your back against a wall.  Place your feet 12 to 18 inches out from the wall.  With your arms crossed over your chest, slowly squat to a depth you are comfortable with.  Start small and as you get strong you will be able to go a little deeper.  Be sure your knees stay in line with your hips and ankles.  Don’t allow your knees to cave in.  Hold the down position for 2 to 3 seconds, and then push up fast back to a standing position.  Perform 8 to 12 repetitions for 2 to 3 sets.


Your glutes are the key muscles that extend your hips to stand up or climb a flight of stairs. The bridge is a great glute exercise to start with.  Begin by lying on your back with the hips bent and your feet lined up with your shoulders.  Perform the bridge by lifting both your hips from the floor.  A common mistake is to excessively arch your low back.  Hold the bridge position for 2 to 3 seconds then return to the starting position slowly over 5 seconds. Perform the lift fast but lower your body back down in a slow and controlled manner.  Perform 10 to 15 repetitions for 2 to 3 sets.

Clam Shell

Your abductor muscles on the outside of your hip are important for stability when you walk, run, or climb stairs.  When these muscles are not working properly, you will walk with a side to side lean or lurch.   This will increase joint stress and increase your risk for falls.

Lie on your side with your hips and knees slightly bent.  Keep your feet together.  Pace a resistance band around your thighs just above your knees. Start the exercise by rotating the top hip to bring the knees apart. Hold this position for 2 to 3 seconds and then return to the starting position slowly over 5 seconds. Be sure to remain completely on your side with one hip stacked on top of the other.  Allowing the pelvis to roll back during the movement is the most common mistake with this exercise. Perform 10 to 15 repetitions for 2 to 3 sets.

Hip Abduction

Lie on your side with the bottom hip and knee bent.  Keep your top knee straight.  Your top hip is maintained in neutral or slight hip extension with the toes pointed forward.  Point your toes forward to orient your hip properly. Initiate the movement by lifting your top leg about 30 degrees.  Hold this position for a count of 2 to 3 seconds and then slowly lower the leg to the start position over 5 seconds.  Perform 10 to 15 repetitions for 2 to 3 sets.  For those who struggle with this exercise, try doing it standing instead of lying down.

This exercise activates the gluteus medius to a greater level than the clam shell.  However, it is also more challenging to perform correctly.  Similar to the clamshell, it is important to remain completely on your side with one hip stacked on top of the other.  Allowing the pelvis to roll back during the movement is the most common mistake.   Also, as your muscle tires, your leg will drift forward into hip flexion.  It is important to maintain your leg lined up or slightly behind your upper body.

Hip and Knee Arthritis: Get Started with Strength Training

The hardest part to any exercise program is getting started.  Commit to performing these exercises a few times each week.  You will see small changes after a few weeks.  Expect to see the best results after consistently exercising for 6 to 12 weeks.  If you don’t feel like you can do it alone, give your physical therapist a call.  The physical therapists at BSR are committed to helping you move without pain.  Exercise is the first treatment for arthritis before resorting to drugs, injections, or surgery.  We want to help you take back control of your health and quality of life.





4 Stretches for Arthritis of the Hip and Knee

Arthritis, according to the World Health Organization, is the single most common cause of disability in adults 60 years and older.  Osteoarthritis is a long-term chronic disease characterized by the deterioration of cartilage lining your joints.  This results in your bones rubbing together creating stiffness, pain, and impaired movement.  Osteoarthritis most commonly affects your knees, spine, and hip joints.  This article is for people suffering with hip or knee arthritis.

While arthritis is related to ageing, it is also associated with a variety of modifiable and non-modifiable risk factors.  Modifiable risk factors you can control include your body weight, exercise, nutrition, bone density, and trauma.  Exercise is one of the primary treatments for arthritis.  However, the most beneficial type and amount of exercise is up for some debate.  This article discusses the benefits of flexibility exercises and stretching for arthritis.  We have also included several helpful stretches for you to start with today.

Stretching is a Proven Treatment for Arthritis of the Hips and Knees

When we look at the entire body of research done on arthritis it is clear that exercise is beneficial.  The type of exercise you choose to perform matters less than how consistent you are.  A 2019 review of 103 different clinical trials found 4 different types of exercise to be beneficial for people with hip and knee arthritis.  These were aerobics, mind-body exercise (yoga or tai chi), strength training, and stretching.  A regular stretching routine was proven to be beneficial for decreasing pain and improving function and quality of life.

Again, the key is to be consistent.  Random or infrequent stretching will offer you little benefit.  The 4 stretches shown in this article are easy to perform in your own home.  They require little, if any, equipment.  Prolonged gentle stretching is better than an aggressive approach. Hold each stretch for 30 seconds and perform 2 to 3 repetitions.  And do them daily!

Chair Hamstring Stretch

Sit towards the edge of a chair.  Extend one of your legs in front of you.  Reach straight ahead with both hands.  Be sure to keep your chest up and back straight.  You should feel a gentle stretch in the back of your thigh or behind your knee.  Don’t bounce or hold your breath.  Maintain each stretch for 30 seconds.  Perform 2 to 3 stretches on both sides each day.

Standing Quadriceps Stretch

Stand with a chair placed behind you.  Rest one foot up on the chair so your knee is bent.  Your knee is aligned directly below your hip. Stand tall. Be sure to keep your chest up and back straight.  You should feel a gentle stretch in the front of your thigh above your knee.  Hold each stretch for 30 seconds.  Perform 2 to 3 stretches on both sides each day.

Kneeling Hip Flexor Stretch

Place a pillow or airex pad under one of your knees.  Your other foot is positioned in front of your body.  Tuck your hips and engage your abdominal muscles.  Stay tall.  Gently lunge forward.  Be sure to keep your chest up and back straight.  You should feel a gentle stretch in the front of your thigh or hip.  Hold each stretch for 30 seconds.  Perform 2 to 3 stretches each day.

Standing Calf Stretch

Stand with one foot back.  Your heel remains in contact with the floor as you lean towards the wall or a counter.  Your knee remains straight to stretch the larger gastrocnemius muscle.  Slightly bend the knee to stretch your deeper soleus muscle.  It is important to stretch both muscles.  Hold each stretch for 30 seconds and perform 2 to 3 repetitions on each side. 

Arthritis: Start Stretching Today

You can take control of your hip and knee arthritis. You don’t have to suffer.  These 4 stretches for arthritis you can easily perform in your home.  They are ideal for decreasing your pain and improving your mobility.  Most people can perform these stretches without considerable pain or difficulty.  The hip flexor stretch may require some modifications if you experience difficulty kneeling.  If you need some help give us a call.  We are here for you.  Many people do better when they perform their home stretches supplemented with manual therapy performed by your physical therapist.