Should you use the exercise machine if you have back pain?
You slide on your wristbands, crank up the Olivia Newton John and take to the nearest machine — your elliptical. Yet you’ve done something to your back recently, and even your favourite song can’t seem to dull the pain as you start working out.
Should you be working out at all?
Physiotherapist Janice Moreside’s recent research is helping others in her field answer that question.
“I’ve been a physiotherapist for 30-some years and in the clinical world, people come in and say, ‘What should I do about the elliptical trainer?’” Moreside said.
“‘Should I use the elliptical trainer?’”
The definitive answer: it depends.
The elliptical has been a popular gym and home gym machine since the 1990s. The questions at her clinic had Moreside looking for more information on the machine, but what she needed was not available.
“On any of those search engines for the peer-reviewed literature, there was nothing that came up that talked about lumbar motion, other than a little bit of forward motion. But we move in three axis. We move to and fro, side to side and we twist, or combinations thereof. So nobody had looked at side to side and nobody had looked at twist and the different variables, like how tall you are, whether you use the handles or not,” she said.
Information could be found on the muscular activity on the elliptical, the cardiovascular impacts, the workout on the legs, but nothing on the spine, she said.
“As a physiotherapist, to be able to say to somebody, ‘Oh you have back pain, yes or no, you maybe should or shouldn’t use the elliptical,’ we had no research to back that up,” Moreside said.
In completing her PhD at the University of Waterloo, she decided to start her own research project on the subject (under the supervision of Dr. Stuart McGill).
“I looked at the elliptical trainer and I looked at it in terms of people’s body makeup — so their height, their leg length, things like that,” she explained.
“We used two different speeds, so if you go normal speed (self-selected) or fast (increased by 30 per cent), we looked at three different hand positions: using the elliptical handles, freehand, or holding onto a central stationary bar.
“I also looked at two stride lengths and most ellipticals don’t have that option. We could change it from 18- to a 26-inch stride length,” she said.
In examining the body movement using the many variables, Moreside went beneath the surface of the information that was previously available.
She tapped the resources of the spine lab at Waterloo, using an imaging system of eight cameras and 86 sensors to create skeleton images of her subjects.
“That’s tracking the motion. So you know in computer-generated animation? That’s the exact same system,” she said.
Information collected by the imaging system runs directly through a computer program that provides numerical data for comparison study.
“It’s a software program used for biomechanical research. So it then gives me this — the spine angles, so spine motion, flexion, extension, side-bending and rotation,” she said.
Participants ranged in height from 5’2” to 6’4”. They were all men, but Moreside said she feels the results would apply as well to women.
In late July, she presented her findings at the Canadian Physiotherapy Association conference in St. John’s under the heading: “Spine Motion on the Elliptical Trainer: should we be concerned?”
“For every condition, no matter what hand position they used or what speed they went, they leaned forward more than they would in walking. So if you have a lower back problem that doesn’t like to bend forward, like a lot of discs are, no matter what you do on the elliptical, you will bend forwards. And, if you go faster, you bend forwards more. If you use the bars, you bend forwards the most,” she said.
As a physiotherapist, you can’t kind of say, ‘It’s great for your back’ or, ‘Oh, it’s bad for your back.’ If your back doesn’t like rotating, well you should probably hold the bars. But it your back doesn’t like flexing, you should probably go freehand. Physiotherapist and researcher Janice Moreside
Then there is twisting.
“Again, in every condition but one, you rotate more than walking. Significantly so. And again, the faster you go, the more you twist. The longer the stride length, the more you twist. And you twist the most when you use the handles, the least when you hold the bars,” she said.
Bending side-to-side was a different matter.
“At the end of the day, the average forward lean angle and twist are significantly greater on the elliptical when compared to walking. Yet, side bending is significantly less,” she said. “People don’t often come in and say, well I can’t bend side to side … but it’s significantly less on the elliptical.”
What it means
There’s a subset of the population for whom the elliptical trainer aggravates lower back pain, Moreside said.
“So, if you had a disc problem in your back that doesn’t want — that is aggravated by lumbar flexion, by leaning forwards — then it’s probably not the (exercise) medium of choice for you at this point in time,” she said.
“If, however, you are somebody who’s older and have a back that doesn’t like bending backwards, and is irritated by bending backwards, then it may be good, because you’re opening up those joints and they may be much happier bending forwards.
“As a physiotherapist, you can’t kind of say, ‘It’s great for your back’ or ‘Oh, it’s bad for your back.’ If your back doesn’t like rotating, well you should probably hold the bars. But it your back doesn’t like flexing, you should probably go freehand,” she said.
Variables like height also make a difference.
“Hand positions, stride length and speed, they have a significant effect. So you need advice, perhaps, as to what you should use,” she said.
“You should hold on to the central bar if you want to flex forwards, because your back is old and arthritic and you don’t want to twist. The bar, then, is your friend. But if you’ve got a back with a disc problem, you don’t want to be bent forward that much, you should maybe go freehand or use the handles.”
In other words, Moreside’s research helps provide a basis for recommendations, allowing physiotherapists to take into account specific back problems.
“That’s where physiotherapy comes in nicely, is we can look at people and say, ‘Oh I think your back problem is due to a joint irritation, or I think you are in the early or mid stages of a disc problem, therefore if you’re going to use the elliptical trainer, these are the parameters you should use.’”
Moreside added she would not dismiss the elliptical outright — it’s a good workout.
“It’s a huge workout for your glutes. For your glute med, glute max, it’s far better than walking,” she said.
“And,” she said, grabbing the side of her upper thighs, “glute med is a hard one. It sits on the side.”