After Back Injury, When Is Exercise a Bad Idea? Physical therapist Sridhar Yalamanchili offers tips to avoid further spine injury while working out

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According to Physical Therapist Sridhar Yalamanchili with Atlantic Spine Center, when exercising after a back injury the first rule of thumb is to work around – not through – pain.

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Don’t force yourself to exercise through excruciating pain. But if you’re coping with some lingering achiness, that doesn’t rule out your workout.

January 2015 – After a spine injury, your pain may wax and wane, proving immobilizing at first and then dwindling to barely a twinge. But whether you’re a weekend warrior, gym rat or somewhere in between, it’s natural to worry about further spine injury and wonder when to hold off on working out – or when to keep exercising, according to Sridhar Yalamanchili, PT, MSPT and Director of Rehabilitation at Atlantic Spine Center.

Though many experts agree that exercise is one of the best ways to maintain a healthy back, we may be wary about working out because of fears of re-injuring the spine once recovery is underway. Exercise can be problematic if done improperly, Yalamanchili says, but the muscles supporting the spine can weaken when we’re sedentary, making us more prone to injury in the first place.

The first rule of thumb, Yalamanchili explains, is to work around – not through – pain.

“Don’t force yourself to exercise through excruciating pain,” says Yalamanchili. “But if you’re coping with some lingering achiness, that doesn’t rule out your workout. Just because one area of the neck or back was injured doesn’t mean you need to avoid moving the entire spine.” There is a strong body of evidence pointing to the atrophy of spinal stabilizer muscles (also called core muscles) with inactivity, making it harder to achieve a strong and healthy spine.

‘Spine tuning’ your back with exercise
Indeed, exercising can be difficult while in pain, but it’s often a key way to heal from injury and prevent future episodes of pain, Yalamanchili notes. One of the main goals of physical therapy, Yalamanchili specialty, is to teach patients how to exercise properly – which, done right, can strengthen muscles and improve endurance and flexibility.

“Pain and aches are typical after a spine injury, but intense pain should serve as a warning to avoid certain exercises,” he says. “However, there are other muscle groups surrounding the affected area that you can still strengthen and stretch.” Doing a crunch or plank is not the only way to start strengthening your spine. Often there is poor flexibility of the lower extremities that needs to be addressed just as importantly as strengthening, to prevent pain recurrence.

With about 80% of American adults suffering from back pain at some point in their lives, Yalamanchili points out that without some “spine tuning” – strengthening your back through exercise and adopting spine-healthy habits – chances are significant of re-injuring the spine within months after the initial injury.

Tips to guide workouts
With this in mind, Yalamanchili offers this additional advice to safely resume working out two to three weeks after a back injury:

  • Introduce one new movement every two- three days and wait to see how your body responds. Only add more movements after determining your comfort level with each previous one. In general avoid exercises that involve any twisting of the spine till your back is pain free.
  • Try low-impact exercises such as walking, using a cross trainer (elliptical machine) and stationary biking, which can boost blood flow to back muscles while diminishing pain and stiffness.
  • Strengthen your “core” – the group of muscles in the abdomen and back that support the spine – with slow, gentle, repetitive movements such as those incorporated into yoga or Pilates. A guided yoga or Pilates program is beneficial especially if you have a fear of movement. A good instructor should be able to adapt the program to someone who is recovering from a back injury, just inform them ahead. These programs are also a good way to keep your back in shape after your course of physical therapy/ home exercise program ends.
  • As more time passes after your back injury, you may be able to add lunges, squats, planks and other moves that strengthen several core muscle groups at once.
  • Avoid high-impact exercises such as jogging, contact sports, racquet sports, golf, weight lifting, dancing or sit-ups until your doctor or physical therapist says it’s OK.
  • Also avoid performing back stretches on a stability ball, which places a great deal of stress on an already-weakened spine.    
  • Do not forget to avoid all the bad postures that you know are causing you pain, be it at your work desk or slouching in the couch at home.

“It’s a common myth that back pain means you should avoid activity for a long time,” Yalamanchili says. “But experts don’t recommend being sedentary in order to avoid re-injuring your spine. In fact, a comprehensive workout regimen should include exercises that stretch, strengthen and condition the back and rest of the body. Seeking the advice of a physician or physical therapist for exercises to safely rehabilitate the back is desirable.”

Atlantic Spine Center is a nationally recognized leader for endoscopic spine surgery with three locations in New Jersey in West Orange, Edison and North Bergen.

Sridhar Yalamanchili, PT, MSPT, is Director of Rehabilitation at Atlantic Spine Center and specializes in orthopedics and sports injuries.

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Melissa Chefec
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