I am very often asked by patients, both those who have undergone surgery and those for whom surgery for lumbar back ache is not available, what exercise regime they should follow. There is a generally held view that a structured exercise program must be good for maintaining spinal hygiene and there is no end of work hardening programmes, core strength exercise programmes and abdominal muscle strengthening regimes etc. etc. touted to restore the spine to pristine health, almost all of them lacking much hard evidence of real efficacy.
I tell them to walk. Preferably 30km a day. This is usually accompanied by stunned silence in response, followed by: “How can I possibly do that?” I point out to them that the human body was adapted by evolution to track 30km across the African Savannah every morning to catch a Mastodon for lunch and it has not evolved much beyond that. I know that Mastadons are creatures of the Serbian Tundra and not the African plains but I am using poetic license to paint a picture.
Some years ago I met a patient who came to see me about issues unrelated to his back but he started talking about his back problems: he injured himself and developed severe back ache. He sought treatment from a variety of physiotherapists and chiropractors and manipulators over a period of many months all to no avail; eventually he was referred to a surgeon who then carried out some form of operative procedure on his lumbar spine but even after that he was not much better. He was under the New Zealand ACC system (this occurred when I was working in New Zealand) and following the failed surgery he went on a further program of physiotherapy, hydrotherapy, pain management and spent some 3-4 years undergoing a variety of increasingly futile attempts to rid him of his disability.
He said that finally one day he got sick of being an invalid and decided he was going to go out and get himself a job, back pain or no back pain. The only job that he could find was to sell Sky subscriptions as a door to door salesman (Sky is the New Zealand version of Fox) and so he trudged door to door in the wind, rain and snow (this was in Christchurch) burning up many kilometres of footpath a day. “You know Dr B, after 3 months my back pain had completely gone and I haven’t had a day of back pain since.” Naturally this is an anecdote but there is support in the literature for both a vertical (as opposed to sitting) lifestyle and walking as a low impact programme for spinal health.
So walking is very much the best exercise for maintaining spinal hygiene. Swimming is just about as good and bike riding (as long as this doesn’t involve hurling yourself off a mountain bike) is not bad either.
– Dr Janusz Bonkowski