Can Exercise Take the Knee and Back Pain Away?

In pain? You're not alone.
According to a survey of 28,900 adults back in 2003, 13 percent of the American workforce lost productivity in a two-week period due to pain. More recent statistics from the Centers for Disease Control and National Center for Health Statistics showed that knee and low back pain affect 19.5 and 28.1 percent of Americans, respectively.
And it's not just lost productivity that's at risk: Pain can keep you from doing things you love, from concentrating on the time you're spending with your kids or grandkids, and it can keep you from exercising, which can ultimately shorten your life. But if you're experiencing chronic pain, should you really be skipping the gym? Or, could exercise actually be an answer to chronic pain?
For back and knee pain, the research says, well, maybe. You should always see a doctor before beginning an exercise program, but exercise has been found in multiple studies to not only relieve pain, but increase the sufferer's future threshold for pain through a process called "exercise-induced analgesia." For knee pain, multiple studies have found that isometric exercise of the quadriceps, where the front of the thigh is flexed in a static position for a prescribed period, reduced knee pain and future incidents of that pain by strengthening the thigh muscle. In a JAMA Internal Medicine review of 23 relevant studies, researchers found that for back pain, there was "moderate quality" evidence that exercise paired with back pain education reduced future episodes of low back pain.
The education step is key: In studies where participants did exercises for low back pain without education on its root causes, the evidence that patients were helped was significantly reduced. Your pre-exercise doctor's visit or a visit to an expert on posture and biomechanics is a good opportunity to get information on why you might be experiencing pain and how to alleviate it.
"The biggest faulty body alignment that is the underlying cause for low back pain is undoubtedly a pelvic deviation or misalignment," says Aaron Brooks, a biomechanics expert and the owner of Perfect Postures in Massachusetts. Pelvic misalignment, Brooks says, can be either a consistently rotated pelvis or one that's elevated on one side, causing constant compression on the vertebrae of the lower back. "Most people don't realize they have these deviations unless they get evaluated."<pagebreak
Unfortunately, many exercises that have shown results for alleviating pain are tough to reproduce at home—they involve laboratory-specific gizmos that aren't found in your gym, calibrated to have the patient flex a muscle at a very specific percentage of total strength. Some studies, though, have used exercises that you can try at home with little to no equipment. If you're experiencing back or knee pain, and you've talked to your doctor, experiment with these 10 moves designed to strengthen your body and potentially reduce future incidents of pain. Brooks and Craig Ballantyne, owner of Turbulence Training and author of "The Great Cardio Myth," share their best form tips to ensure that you perform each move safely and efficiently every time. If your pain increases, stop the movements for the time being and consult a doctor to determine the best course of action for your particular situation.

Knee Pain, Knee Pain Go Away

Multiple studies have used the four following exercises to help alleviate knee pain. In one study published in the Annals of the Rheumatic Diseases, 191 men and women between the ages of 40 and 80 who suffered from knee pain saw a pain reduction of 22 percent after performing these moves daily for just six months.
1. Seated five-second isometric quadriceps contraction

The first exercise is an isometric, or static, quadriceps contraction. To begin, sit against a wall with your back supported, legs extended and a rolled-up towel under one knee. Contract the front of the thigh to press the towel against the floor, holding for five seconds. Move the towel to the other leg, and repeat. Perform up to 20 repetitions per side.
For an alternate seated quadriceps exercise, Brooks suggests sitting in a similar position, but with your back away from the wall and your hands on the floor to help you sit up straight. With feet flexed towards your waist, lift one leg off the floor, keeping the foot flexed back and the quadricep contracted. Repeat the lifting and lowering for 10 reps and then switch legs. Repeat for two to three sets total.
2. Mid-flexion seated hold

Sitting in a chair with your back straight and feet flat on the floor, raise one leg off the floor halfway up and hold for five seconds. Return to start, then repeat with the other leg. Perform up to 20 repetitions on each side.
3. Prone hamstring contraction

Lie face down on a mat or soft floor surface, with arms at your sides and legs straight. Bend one knee to bring your foot up toward your butt, keeping your hips square and on the floor. Return to start, and repeat on the other side. Perform up to 20 repetitions per leg. 
4. Bodyweight step-up

The bodyweight step-up is as simple as stepping up and down from a single step. To keep tension on the correct muscles and to keep your knee safe during the exercise, though, Ballantyne recommends focusing "on 'pulling' yourself up to the top position using the [hamstrings and glutes]." One way to keep focus on the backs of your legs is to raise your toes off the ground—and keep them there—as you start the movement, keeping weight in your heels. "Keep your chest up, your head up and your abs slightly braced" as you step up, is Ballantyne's advice. Then, as you come down, he says to focus on the quadriceps as you slowly lower yourself, rather than slamming back down.

Bye-Bye Back Pain

1. Passive prone extension

In a study of 314 Danish military personnel, study participants were educated about low back pain and prescribed to perform the passive prone extension exercise described below. Those who performed this exercise 15 times per day were significantly less likely to report low back issues or injury during their remaining time in the military when compared to those who did not do the exercise.
Again, be sure to consult your doctor before performing this or any move, Brooks says. "If someone has a pre-existing disc bulge or herniation, this exercise could actually irritate the low back pain."
To perform, lie face down with your legs straight and palms flat on the ground just outside the chest at the nipple line. Keep the shoulder blades together as you press through the arms to extend the low back and raise the chest. Hold for a moment, then return to start. Repeat 15 times.
"If the exercise bothers [your] neck," Brooks says, you can "allow the head to hang or keep it neutral where there is no pain."
2. Supine glute contraction

In a small pilot study from 2012, a series of six exercises focused on balance-control were used daily in a system that kept participants who performed them from experiencing low back pain in the year that followed. About 60 percent of participants who did not perform these exercises did experience low back pain during the same period. The five listed here require no special equipment and can be performed at home.
The first exercise is a lying glute contraction. Lying with arms interlaced behind the head and legs out straight, squeeze your butt while keeping your elbows on the floor. Hold the squeeze for a second and release. Repeat 25 times total. 
3. Supine vacuum with rotation

This exercise works your transverse abdominis, or TVA, a muscle that encircles your organs and braces them against your spine. To do this move, lie face up with elbows behind your head. Take a deep breath in, then exhale all of the air out of your lungs as you lift and expand your chest while drawing your belly button towards your spine. Don't hold your breath; keep your stomach sucked in as you take in your next breath and try to bring your navel closer to your spine with each exhale. Lift your legs off the floor slightly and create small circles while keeping your legs straight and elbows on the floor. Circle 15 times.
4. Glute bridge

Lie face up on a mat with your knees bent and feet flat on the floor. Place your arms at your sides, palms up. Keeping your feet flat on the floor, squeeze your glutes to slowly raise your hips off the floor until your body forms a straight line from your knees to your shoulders. Hold at the top for a count of five, then slowly return to start. Repeat five more times.
5. Supine twist

Lie face up on a mat with your legs straight and arms out, forming a "T" shape. Draw your right knee towards your chest so your leg forms a 90-degree angle. Rotate your knee to the left so it drops over your left leg and your spine twists. Take care to keep both shoulders on the floor throughout the movement. To enhance the stretch, turn your head to look in the opposite direction. Hold for five seconds, then switch sides.
6. Standing broomstick twist

Stand with feet hip-width apart, with a broomstick held over your shoulders. Keeping your eyes focused on a spot on the floor in front of you, twist your torso to the right while your feet stay in place. Slowly twist back to start and repeat to the left. Perform 20 total twists.
Whether it's due to age, your joints or a preexisting injury, knee and back pain affects many, but it doesn't have to slow you down. Learn to incorporate a few of these moves into your morning routine and, over time, you might find that you're stronger, healthier and better equipped to handle your pain.