Low impact aerobic exercises are helpful in improving strength, endurance and conditioning of soft tissues as well as joint cavities. For long term management of low back pain, healthcare professionals often advice low impact aerobic exercises for pain relief and early restoration of normal day to day activities.
Back pain is a common complaint that reportedly affects almost 80% individuals at some point of their life. While most episodes of low back pain are acute and severe, vast majority of patients develop chronic and low intensity back pain that is gnawing, agonizing and depressing.
It is very important to choose the type of therapy after understanding the cause of pain. For example, high impact exercises are much better at improving weight loss, yet such activities are also almost always associated with a high risk of injury.
Most cases of chronic low back pain are caused by:
- Long standing inflammation due to bone demineralization
- Stretching or spraining of major muscles, ligaments or other connective tissue elements (for example most cases of low back pain in pregnancy are caused by round ligament stretching)
- When cause of pain is small muscles and tissues (that are often missed during high impact exercises that normally aims at strong bulky muscles)
Low impact aerobic exercises are mainly conditioning exercises that improves blood circulation, reduce tissue swelling and stimulate neuromuscular segments in order to prevent future injuries.
Some of the most effective low impact aerobic exercises to alleviate low back pain are:
Brisk walking should be incorporated in daily routine to prevent back pain and degenerative bone disorders. Walking is the most convenient and popular form of low impact aerobic training that promotes complete body-workout (instead of targeting a specific tissue or limb).
According to the research published in BMC musculoskeletal disorders (1), walking (both under-supervision and unsupervised) can help in reducing the low back pain. Investigators reported that study participants consumed less pain medications during the study period and reported overall better health and mood, which is why patients with low back pain should be encouraged to walk. The authors also reported that used alone, walking is not the most effective treatment for back pain, it can however reduce the risk of recurrence.
Depending upon individuals preferences, other varieties of low impact aerobic exercises that are similar to walking are:
It is recommended to speak to your healthcare provider regarding the most appropriate strategy in your case.
Stationary bi-cycling is useful for those individuals’ who have difficulty in standing, walking or running due to musculoskeletal conditions. Stationary bicycles are now commonly available for home-use as well. However, experts and healthcare providers suggest that compliance is much higher in general population with dynamic bicycling.
According to the research report published in peer reviewed journal Spine (3), author suggested that bicycling delivers comparable results to specific trunk exercises in patients of chronic low back pain.
Step machine, also referred to as elliptical machine. It helps in maintaining low impact aerobic exercises by applying force on the suspended pedals to allow movement in oval-direction. This provides the advantage of not having to step on the hard surface. Another benefit of using step machine is to allow the individual to exercise upper limb muscles as well.
Submerging your body in water gives the feeling of weightlessness, this also helps in relieving the stress from the spine. Research report published in Physiotherapy Research International (2) explained that most individuals are unable to perform land exercises adequately. The primary reason is stiffness and back pain that limits the flexibility, endurance and range of motion.
However, when the same stretching exercises are performed under water (as part of a recreational activity such as swimming), remarkable results are usually achieved. Most importantly, the buoyancy effect of water helps in strengthening the lower back muscles, hips and also biceps. Exercises performed under water reduces the stress and prevent vertebral fractures and nerve compression syndrome in the long term.
Yoga allow patients of low back pain to adopt various poses that improves strength and flexibility of connective tissue matrix. Not only yoga improves the stability of muscles but also enhance flow of blood and energy across the spine to improve mood and overall sense of well-being.
According to a study published in The Clinical Journal of Pain (5), author suggested that yoga postures are extremely helpful in short term as well as long term management of low back pain in individuals of all age groups. This conclusion was drawn after carefully analyzing 10 clinical trials and approximately 1000 patients. The report also concluded that yoga is not associated with any adverse effects or complications.
Some excellent yoga poses for lower back pain management are:
- Lie flat on your stomach.
- Now slowly inhale and while inhaling, slowly raise your upper torso above the ground.
- Inhale until your back is gently arched, your upper limb is drawn inward and your elbows are slightly flexed.
- Make sure to gently elongate or stretch your neck as well.
- Hold your breath for a few seconds.
- Now exhale and slowly release your body back to neutral position.
Wild Child Pose
This pose is opposite of what you just did in previous pose.
- Sitting on your knees and hands (that will be your neutral position).
- Now stretch your arm forward and lower your torso in the praying pose (with your belly between your two knees)
- Gently exhale as you relax your body in the wild child pose
- Return to neutral position and perform this pose at least 5 times each day
The beauty of low impact aerobic training lies in the fact that most activities are recreational (suggesting a higher rate of compliance and lower risk of tissue as well as joint injuries). Hiking is also classified under low impact aerobic training that can be used as a fat-burning exercise (if you are hiking up a hill or mountain).
In order to increase the rate of caloric burning, you can carry weight (in the form of back pack). Once again, recommendation from your healthcare professional is advised for best results.
According to data reported in 2005, more than 11 million people practice pilates or routine basis due to health benefits and ease of use. According to a new research conducted by Sureeporn Phrompaet and associates (4), it was suggested that twice weekly sessions (with each session of 45 minutes) over a period of 8 weeks, the strength of lower back muscles and stability of pelvic or lumbar segments can be improved significantly.
Among the 20 study participants, more than 85% passed the test for lumbosacral stability after 8-week training. The core principles of pilates revolves around muscular strength, tissue conditioning, flexibility and endurance.
Low to moderate intensity workouts could be fun, especially if you are fond of dancing. Zumba, aerobic dancing allow patients of chronic low back pain to optimally exercise all the muscles of the body without having the feel of “treatment” or “therapy”.
Under the standard guidelines, 75 minutes per week of intense Zumba dancing or 150 minutes per week of moderate zumba dancing are sufficient to maintain optimal health and reduce the risk of joint or tissue injury as part of the physical activity.
What are the benefits of low impact aerobic exercises?
- Low impact aerobic exercises increase blood flow to the connective tissues (muscles, ligaments and joint cavities).
- The primary aim of physical activity is to mobilize stiff and quiescent muscles. Yet, vigorous activity of muscles can lead to lactic acid production, generation of free radicals and build-up of carbon dioxide along with other waste products that may alter the course of recovery. Low impact aerobic training prevents these events and reduce stiffness without altering the oxygen concentration of tissues.
- Aerobic exercises reduces tension and stiffness in muscles and joints. These are much easier to perform that high impact exercises (that are fairly painful in case of moderate to severe injury, tissue swelling and stiffness)
- Low impact exercises that target back muscles helps in the natural re-alignment of spinal vertebrae and helps in the maintenance of anatomical and physiological posture to reduce wear and tear changes in the tissues.
- Aerobics helps in decreasing the total body weight via natural methods and assists in long term control. It helps in decreasing joint and spine pain.
- Aerobic exercise increases endorphins that helps in combating pain, endorphins are natural pain killers, they are also helpful in releasing stress.
What are the other indications of low impact aerobic exercises?
- Besides the optimal management of back pain due to musculo-skeletal issues, it has also been observed that aerobic exercises are also helpful for patients with known history of complicated inguinal hernia that is causing leg pain due to nerve compression.
- Patients with known history of advanced degenerative disc disease can also find relief from these exercises. These patient should sit and flex their back forward to relax the spine. By doing this, it releases disc pressure and reduces pain significantly.
- In situations when a person is unable to perform high intensity exercises due to pregnancy, acute injury, osteoporosis, high risk of stress fractures (especially in professional athletes) or other causes, low impact aerobic exercises are usually the first choice for pain relief as well as rehabilitation to improve the quality of life.
- Patients with chronic metabolic or circulatory issues (such as hypertension, cardiovascular diseases, diabetes) are poor candidates for high intensity exercises and can therefore get highly benefited from low impact aerobic training that strengthen heart and stimulate normal lung functioning.
- Likewise, if you are obese (or over-weight), it is highly recommended to start the weight loss regimen with low impact aerobic training to minimize the risk of joint trauma.
Lifestyle Modifications For Low Back Pain Relief
It has been observed that identification of triggers and optimal management of risk factors can also help in decreasing the risk of chronic low back pain. For example, when it comes to driving, no one really thinks of how it can trigger or aggravate an underlying condition. For instance, drivers who suffer from back pain may find themselves under severe pain and stress after a driving session.
This indicates that prolong driving (and some related factors associated with driving seat and driving posture) can put unnecessary pressure on the vertebrae in such a manner that it may lead cause, trigger or aggravate backaches and spasms. What a person must do, if he finds himself facing such a condition more often is to make certain adjustments to his lifestyle that will help soothe the condition.
First and foremost the driver should adjust his seat in such a manner that it prevents him from slouching. Besides, his arms should be at a comfortable length and not so close to the steering. Otherwise it may stress the neck and arm muscles.
Other adjustments and lifestyle modifications that can help this condition on top of the low impact aerobic exercises are as following.
- Heat and cold therapy: Using warm towel or ice pack is one of the most reliable and ancient method of alleviating acute and chronic backache. Exposure to colder temperature via ice-packs or cold compresses is helpful in reducing pain sensation and swelling. Similarly heating can help reduce inflammation and swelling to ease muscle and joint movements. Both these simple strategies can used alternatively several times throughout the day.
- Stretching: Sometimes not using the muscles enough can jam them, therefore exercising these muscles can help in reducing pain and making the connective tissue alignment stronger. However, often times inflamed muscles are tender and stiff, which is why stretching exercises are extremely helpful.
- Adequate rest: Giving adequate rest and relaxation to the tissues can help in early restoration of normal tissue anatomy and physiology. Over-resting can however be hazardous due to increased risk of stiffness and spasm.
1. Hartvigsen, J., Morsø, L., Bendix, T., & Manniche, C. (2010). Supervised and non-supervised Nordic walking in the treatment of chronic low back pain: a single blind randomized clinical trial. BMC musculoskeletal disorders, 11(1), 30.
2. Lindsay, D., & Horton, J. (2002). Comparison of spine motion in elite golfers with and without low back pain. Journal of sports sciences, 20(8), 599-605.
3. Brooks, C., Kennedy, S., & Marshall, P. W. (2012). Specific trunk and general exercise elicit similar changes in anticipatory postural adjustments in patients with chronic low back pain: a randomized controlled trial. Spine, 37(25), E1543-E1550.
4. Phrompaet, S., Paungmali, A., Pirunsan, U., & Sitilertpisan, P. (2011). Effects of Pilates training on lumbo-pelvic stability and flexibility. Asian journal of sports medicine, 2(1).
5. Cramer, H., Lauche, R., Haller, H., & Dobos, G. (2013). A systematic review and meta-analysis of yoga for low back pain. The Clinical journal of pain, 29(5), 450-460.
6. Saper, R. B., Sherman, K. J., Delitto, A., Herman, P. M., Stevans, J., Paris, R., … & Weinberg, J. (2014). Yoga vs. physical therapy vs. education for chronic low back pain in predominantly minority populations: study protocol for a randomized controlled trial. Trials, 15(1), 67.