Trinity Medical Center I Dr. Marin Guentchev, MD, PhD

How to Determine the Proper Exercise Dosage for Patients with Chronic Back Pain?

author: Marin Guentchev, MD, PhD

2020-07-29
Proper Exercise Dosage for Patients with Chronic Back Pain
I have noticed that immobilization is one of the leading causes of neck pain and low back pain. Apart from the fact that I often see patients with such complaints, I suffer from back pain after standing in the operating room for a long time.

Over the years, in my clinical practice, training an elliptical became a useful way to control neck and lower back pain caused by immobilization.

A research group from the Department of Physical Medicine and Rehabilitation, University of Pennsylvania School of Medicine, Philadelphia, PA, USA, did an exciting experiment.

Patients suffering from lower back pain underwent a six-week exercise program using the elliptical trainer three times each week. Exercise duration was steadily increased each week for the length of the study. The total cumulative amount of work that coincided with significant reductions in chronic low back pain was then identified.

At four weeks, pain scores were reduced significantly. This pain reduction corresponded to an average of 30.8 Kcal/kg of body mass in cumulative work performed.

These findings suggest that approximately 30.8 kcal/Kg of accumulated physiological work is a therapeutic "dosage" of exercise needed for a significant reduction in chronic back pain.

What is an elliptical?
An elliptical is an exercise machine, found in every fitness center. The elliptical simulates several aerobic exercises, but most of all, it looks like cross-country skiing. The device has pedals suspended above the ground, which move back and forth. Because the pedals do not touch the ground, the shock of landing the foot on a hard surface is eliminated, which is advantageous for many patients suffering from spinal diseases.

The suspended pedals slide on an improvised elliptical trajectory. Most machines are designed so that you can choose the strength of your load. This type of training protects the spine from impact due to its sliding effect of movement.

Advantages of the cross trainer:
Very low level of stress on the spine as well as on other joints and bones.
It provides efficient cardiovascular training while helping to build muscle mass (when the device is set to give greater resistance).
Most elliptical trainers allow adjustment of inclination and resistance levels.
The elliptical also has handles for the arms, which provides a load in the upper part of the body.

Disadvantages of the cross trainer:
Some people find it difficult to perform the initial movement, necessary to activate the machine.
Home ellipticals are not comfortable, and patients often lose motivation to use them.
Professional ellipticals are comfortable, but also quite expensive. The basic models cost from 2000 to 4000 BGN. The good news is that an elliptical can be found in any fitness center.
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