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                            ADVANCED BACK EXERCISES 
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       The basic exercises in the previous chapter will begin to attack 
       the source of most backaches. But as with most plans, the body 
       is the sum of its parts and a general exercise program to 
       increase overall body strength and cardiovascular output from 
       the heart and lungs goes further to enhance life and freedom 
       from pain for a back pain patient. In addition, more difficult 
       back and spinal exercises are also presented in this chapter. 

       Many physicians who treat back pain sufferers recommend a 
       comprehensive exercise program in addition to specific back and 
       spinal conditioning. What sports and exercises are best? 

       On the preferred end of the scale, the following sports and 
       exercises are generally save for back pain patients. Note that 
       for the most part these activities feature CONTINUOUS motion, 
       LOW IMPACT potential and MILD TWISTING AND TORSION to the lower 
       back and torso: 

       1) Walking briskly for twenty to thirty minutes daily. 2) 
       Bicycling with legs fully extended and minimum crouch. Be 
       careful lower back is straight and free from "swayback" position 
       or excess lordosis. 3) Swimming using low stress strokes such as 
       the crawl or sidestroke rather than butterfly stroke or diving. 
       No sprinting. 4) Rowing if allowed by a physician. 5) Stair 
       climbing machine. 6) Cross country ski simulation machine. 

       Sports activities NOT generally encouraged for back pain 
       patients normally have the potential of EXCESSIVE IMPACT OR 
       EXCESSIVE TWISTING AND JERKING. They are also less than perfect 
       as aerobic exercise since they are not continuous. For example, 
       you undergo an intense burst of energy while running and batting 
       during baseball followed by longer periods of general 
       inactivity. The same is true of most of the other activities on 
       the following list of activities NOT recommended:

       1) Football 2) Golf 3) Tennis 4) Bowling 5) Skiing 6) Baseball 
       7) Basketball 8) Horseback riding 9) Soccer 10) Hockey 11) 
       Weight lifting. 

       As an aside you might wonder which exercise the author has 
       chosen. An avid bicyclist, I take advantage of several hilly 
       roads near my home for my cardiovascular workout. My circular 
       "loop trail" is merely 5 miles long. It first takes me on a 
       scenic winding two mile flat road which later turns up an 
       extremely steep hill about one third of a mile long. Finally the 
       hill returns me to another flat road and the final stretch home. 
       The entire loop takes about twenty minutes and features a nice 
       warmup sitting on the bicycle followed by a standing position on 
       the bicycle as I climb the hill (almost simulating a stair 
       stepping machine in posture) and then a pleasant "cooling off" 
       sprint home and a return to a sitting position on the bicycle. 
       
       The reason I like my personal routine is that it is a fast and 
       intense workout. Joint stress and impact is low. Maybe not your 
       cup of tea, but the important point is that it is convenient as 
       a daily routine and that is the secret to making it work! 

       Additional advanced back strengthening exercises are also 
       available for back pain patients. Again, these should be 
       attempted ONLY with permission of a physician. Continuing our 
       list from the previous chapter... 

       Exercise ten: hamstring stretch. 

       A classic runner's warmup maneuver, but invaluable as an 
       advanced exercise for patients who can do the earlier basic 
       exercise group without pain. Stand facing a desk, chair or low 
       table. Place left heel of foot on edge of table or chair. Place 
       a hand on your extended knee for balance and concentrate on 
       keeping your back straight. Now gradually bend your right leg so 
       that your body begins to lower. You will feel a pulling 
       sensation in your hamstrings. Keep the extended left leg and 
       knee straight. Be careful to slowly do this exercise and do only 
       a few repetitions at first so you cause only a mild stretching 
       sensation. Overdoing this one can cause a lot of pain, so 
       experiment slowly and carefully. 

       Exercise eleven: chin and knee touch. 

       Lay on your back on the floor. Extend right leg and knee 
       straight and allow it to lie on the floor. Bring left knee up to 
       your chest by gradually pulling it with both hands. Roll your 
       head towards your knee and try to touch your chin to the knee. 
       Hold for the count of five then reverse the process with the 
       other leg. Five repetitions. 

       Exercise twelve: scissors. 

       Lie on your back and extend both arms out to side for balance. 
       Lift legs and thighs into the air. Knees may be slightly bent. 
       Slowly and deliberately using thigh muscles, "scissor" right leg 
       past left leg and then spread legs apart. Repeat and "scissor" 
       left leg over right leg. Your legs move from side to side as 
       they cross over each other. Five repetitions. 
              
       Exercise thirteen: hyperextension of lower back. 

       This exercise should only be done with doctor's permission and 
       for those who have previously built up their back strength from 
       earlier exercises. Lay on your stomach. A small flat pillow 
       under the abdomen may help perform this exercise. Place both 
       hands behind back. Keep feet on floor and raise your head and 
       upper chest off of the floor. Hold for the count of five. Do 
       five repetitions. 

       Exercise fourteen: crossovers. 

       Very similar to the previous exercise, but instead of lifting 
       upper body, first raise BOTH the right arm, head and OPPOSITE 
       left leg. Hold for the count of five then switch to raise of 
       left arm and right leg. 

       Exercise fifteen: leg raise. 

       Lay on abdomen as in last exercise, but raise and hold both legs 
       while keeping chest and torso on the ground. You may need to 
       shift the pillow to a position under your hips rather than under 
       your stomach. Hold the extension for the count of five. Repeat 
       five times. 
       
       This tutorial is merely a starting point! For further 
       information on back care and back pain, be sure to register this 
       software ($25.00) which brings by prompt postal delivery a 
       printed, illustrated guide to back pain written by a physician 
       plus two software disks. From the main menu select "Print 
       Registration Form." Or from the DOS prompt type the command  
       ORDER. Mail to Seattle Scientific Photography (Dept. BRN), PO 
       Box 1506, Mercer Island, WA 98040. If you cannot print the order 
       form, send $25.00 to the above address and a short letter 
       requesting these materials. End of chapter. 
       
