What exercises are best...and should be avoided for someone who has lower back pain and knee pain?

Let me start by saying that this is a great forum and I hope we all can learn from each other's specific areas of expertise. As a practicing outpatient physical therapist in ortho and sports, I have seen many sedentary middle age people with low back complaints. Since they are sedentary, joint aching would not surprise me at all. This does not mean necessarily that something bad is going on in the spine or knee. The most important thing is to assess unassisted active range of motion in multiple planes of movement. Look for red flags such as bilateral leg pain, or yellow flags such as numbness and tingling in the lower extremity. You likely to find that this client is not very flexible and will require more spinal range of motion to feel better. If forward bending causes painful radiation, don't assess a sit up--in fact due to the possiblity of a disc problem, I might avoid any crunch until you have a better idea of his capabilities. Assess a plank or incline it if he can't do a full plank--stop the clock if any back pain or changes in form. Perform a side plank as well. If he is able to extend his back in prone without pain, consider a bilateral hip extension assessment as well. Look at seated and standing hip/knee flexibility, keeping in mind that sciatic nerve problems often show up when assessing hamstrings length. For knees, look at a basic squat (depth, symmetry, pain?, etc) and assess active range in flexion and extension (watch that sciatic nerve tension doesn't limit the knee extension). Check quad and hamstrings strength. Do a small step up test--look for anterior knee pain vs. something deeper. Likely not going to have any tendinopathy or IT band friction due to the sedentary nature of his lifestyle. Bottom line is I wouldn't be scared to assess these things--very common complaints, but if there are any abnormal responses, you may want to send them to a local physical therapist or sports med doc for further evaluation. Good luck! For ideas to stretch and strengthen the core, you can go to my website at www.halotrainer.com

Awesome information Bryce. Thank you so much for sharing all of this with me. I do very much appreciated it. Helps a lot!

Tasha...you have described most of my students who sign up for my Nordic Walking (walking with specially designed poles) classes and workshops.
What I find fascinating is that during the intro I do before giving everyone their own pair of poles, I talk about posture and how posture drives all systems in the body. I list daily activities that compromise our posture: sitting in front of the computer, driving, watching TV, walking with our heads down and sitting listening to me! With that last comment, I see everyone grow 3" because they self correct their posture.
I have had measurable success with students who battle back, hip and knee pain. The corrective exercise of Nordic Walking allows them to increase time, distance and intensity with guidance. Better breathing from being upright plus supported spine, pelvis and knees leads to confidence! More confidence leaches feel-good hormones into the system and the upward cycle leads to more pain-free exercise. Usually, the increased amount of exercise translates into weight loss which puts less stress on the joints and back.
As you can see, I am a believer having witnessed people leave their pills and assistive devices behind to Nordic Walk tall and with less pain!

Swimming is the best exercise for your back!

I thought this information would be helpful. It comes from ACSM Exercise Management for Persons with Chronic Disease and Disabilities.

"Little is known about the level of aerobic fitness in patients with chronic LBP, although many rehabilitation programs focus on muscle strength, muscle coordination, or flexibility, especially of core trunk muscles, or some combination of these, as key components of rehabilitation. A number of studies and systematic reviews have shown that exercise is significantly more effective than rest for LBP. There is also a strong evidence that one one specific exercise regimen is superior. Exercise guidelines for individuals with LBP are therefore similar to the guidelines established by ACSM for apparently healthy populations, with appropriate adjustments.

The goals for exercise programming in individuals with LBP are to improve health and well-being increase exercise tolerance and prevent debilitation caused by inactivity. Exercise guidelines that minimize stress to the lower back should be started during the first two weeks of acute LBP. During the acute stage of severe LBP only, exercises for hip and back muscles could be delayed for at least two weeks and the intensity should be low, with gradual increases in intensity and duration. For those with chronic LBP, exercise intensity and duration should also be graded, gradual in progression, and time rather than pain contingent. This is particularly important in individuals who are debilitated or fearful of reinjury. Finally, given that adherence to any exercise or activity regimen is essential if benefits are to accrue, and given that on one exercise regimen is superior, it is essential that exercise or activity prescriptions consider client preference."

Hope this is helpful.

By the way, the exercise testing guidelines for the LBP population are:

1. Maximal and submaximal exercise testing is unnecessary. (It may be warranted if risk factors/symptoms of CAD are present.

2. Strength: isometric trunk testing. (Measure isometric strength in multiple positions to find true peak torque.

3. Flexibility: Straight leg stretch inclinometry: angle to elicit pain or radiating symptoms.

All the best!

Get the book "Pain Free" by Pete Egoscue and follow the instructions. It will help tremendously.

To JOANNE:

"There is also a strong evidence that one one specific exercise regimen is superior...

...and given that on one exercise regimen is superior, it is essential that exercise or activity prescriptions consider client preference."

I am not sure if this was a typo; if not, I don't understand what it is saying???
Is it suppose to be NO ONE EXERCISE...??? You type one one and on one...???

Please advise...and thanks.
Best, Joy

Look at the symptoms....back and knee. What do these have in common? The hip, other things that should be looked at are the thoracic spine and ankle. if the hip mobility is limited then the body will compensate by replacing stability in the lumbar and knee with mobility which is not its job. Do a thorough mobility screening active and passive then work on what needs to be addressed.

I don't know what you mean by "pre-hypertensive." What are your benchmarks for resting systolic and diastolic readings? First step---make sure your client has been cleared by his physician for vigorous exercise. Bryce excellently answered the question in depth.

I would avoid exercises that load trunk flexion. Trunk extension exercises, without exacerbated pain, should be emphasized, prone, trunk extension for example. With regard to the knee pain, I recommend avoiding any high impact lower extremity exercises, focusing instead on low impact (e.g., steps v. jumping.)

Tasha. While I'm a bit late answering your question, I'd still like to address your question (even if not for this particular client). Whenever a client has physical or health "issues" such as chronic pain or an injury, in my opinion it's a requirement that they at least see their physician and get his or her approval before starting their work with me. This will give them, and YOU some peace of mind. Additionally, by requiring this, you are giving their physician the opportunity to let you know if there are any things (exercises etc.) that are contraindicated and that you should definitely NOT be doing with your new client.

LaRue, CSCS
www.lecfitness.com
larue.cook@lecfitness.com