Exercise is an important part of any pain management program. Pain typically causes decreased activity with resultant deconditioning and weakness. This causes decreased work capacity, aggravates depression, and increases the chance of reinjury. Individuals with chronic spinal pain should usually begin an exercise program under the supervision of a physician and physical therapist. There should be three components to a complete exercise program: flexibility training, aerobic conditioning, and strength training.
Flexibility or stretching exercises are important to restore and maintain the proper range of motion of the spine and other tissues, which in turn allows the restoration and maintenance of proper posture and body mechanics. Stretching of the hamstrings and hip flexors is especially important. A gentle hatha yoga program is an excellent approach to flexibility training. It is important to pay close attention to your body's response to yoga (or any exercise) to learn your limits and gently extend them. You should begin yoga training under the supervision of a qualified instructor, if possible.
Aerobic conditioning is often referred to as cardiopulmonary conditioning. These exercises emphasize rhythmic movements of large muscle groups which in turn alter the cardiopulmonary response to exercise and increase work capacity. They are associated with a general sense of well-being, improved coping with pain and stress, weight reduction, and decreased depression. Specific exercises include walking, cycling, swimming, elliptical trainers, etc. The goal is to exercise for at least 30 minutes, at least 3 days a week. A simple walking program may be adequate. If you cannot walk for 30 minutes at a time, then walk for 10-15 minutes 2-3 times a day, and gradually increase the walking sessions until you can exercise to 30 minutes, if possible.
Strength training is important for the prevention of further injury. It is also associated with improved work capacity, a sense of well-being, and improved weight control. Spinal strength training should focus on dynamic stabilization exercises, best learned under the supervision of a physical therapist. For general strength training the use of constrained weight machines in a gym is safer than using free weights. The machines should be adjusted to support the spine and isolate the muscles being trained. Another approach that some of my patients have found helpful is the Pilates exercise program. This approach also isolates the muscles being trained. It should be learned under the supervision of a certified instructor.
Other exercise programs such as the Alexander technique and Feldenkreis are helpful for some people. They both focus on self-monitoring of posture. Tai chi is an ancient Chinese exercise program which utilizes gentle rhythmic movement to enhance flexibility, strength, and endurance.