Hurdling Physical Limitations to Fitness

Q. Can you recommend some exercises for people with physical conditions like arthritis, a herniated disk or bad knees? And don’t just say swimming.

A. We’ve all heard this myth: That swimming is the best form of exercise. In fact, this isn’t really true. That’s because the right exercise and fitness program depends on a person’s particular goals, preferences and needs.

Don’t get me wrong. Swimming in a fine workout, but it’s not the perfect workout for everyone. Yes, swimming is low-impact, so people who are overweight, pregnant, have arthritis or are unstable may find that the buoyancy of the water cushions their movements. But performing traditional strokes like the crawl, breaststroke or backstroke can, among other things, aggravate the neck, lower back and knees in a person who has problems in these areas.

So, what is the best exercise? There’s no-one-size-fits-all answer. A marathon runner, for example, will train differently than a dancer or football player. A marathon runner with a knee-injury will train differently than a marathon runner without one. When you have a chronic health condition, you should consult with a physical therapist or other health-care professional with training in physical medicine to design the proper fitness regimen for YOU. But in the meantime, here are general tips for people with relatively common limitations:

Bad backs: Back problems vary, but some people with a bad back may want to avoid impact exercise like jogging, or they might simply need to minimize, rather than completely avoid, impact—running on soft ground rather than concrete, for example. Some people may need to avoid movements that involve excessive bending, and they may benefit by strengthening the muscles that stabilize the spine, such as the back muscles and the abdominals. But that doesn’t mean doing a hundred sit-ups. The traditional crunch, which involves repetitive back flexing, and many Pilates or yoga movements that extend the legs unsupported away from the body can exacerbate back pain by increasing the pressure on the spine. On the other hand, exercises that target the abdominal muscles in a way that involves little actual movement can help provide the stability a bad back needs.

Try this isometric ab strengthener: Lie on your back with your knees bent. Place your hands underneath the small of your back, then raise your head, neck and shoulders about two or three inches off the floor. Instead of sucking in the belly button to squeeze the abs, “brace” your ab, waist and back muscles (think of tightening your torso to create a wall of resistance as if someone was about to punch your stomach). Hold the slightly lifted, braced position without moving for about 10 seconds while breathing normally. Work up to longer holds.

The key back protector in this move may be the hands held underneath the lower back. Research by Dr. Stuart McGill, a professor of spine biomechanics at the University of Waterloo in Ontario, Canada, suggests that maintaining the lower-back curve during abdominal training provides greater back support. His findings also indicate that when doing ab work allowing your back to flatten to the floor increases stress on the spinal discs. This is especially true when performing lots of repetitions of crunches. (Read his book, Ultimate Back Fitness and Performance, for more.)

Bad knees: As with bad backs, bad knees can result from many causes. For some, riding a bike is painful for their knees; others have no problem with it. Most would benefit by avoiding movement that involves deep knee bends or knee-twisting (such as very deep squats or many yoga moves, like the lotus pose). Generally, someone with knee problems can benefit from strengthening the surrounding muscles, like the quadriceps in the thighs, to help bear some of the pressure that the joint would otherwise take.

A simple quad strengthener is to sit in a chair with the feet flat on the floor and raise one foot at a time to knee level until the knee is straight. Then lower and repeat. Doing one set of eight to 12 reps is a usual starting point. As you get stronger and can easily complete three sets, then add a light weight to the ankle to keep progressing. For those who find it painful to bend and straighten their knee, you can simply raise your straight leg up and down to tighten the thighs muscles, again working up to more reps and gradually adding weight resistance.

Arthritis: This condition can be tricky since pain often discourages people from wanting to move. Yet at the same time, moving less means that the muscles surrounding the bad joints are likely to weaken, which can lead to yet more pain. Because of this, it may be necessary to work through the initial discomfort to obtain the benefit of stronger muscles that will provide support for arthritic joints.

However, if one particular move is too uncomfortable, there are often many ways to work the same muscles, and some exercises may be more beneficial and less stressful than others. In all cases, you need to consult a physical therapist or physiatrist (a physician who specializes in exercise and rehabilitation). Personal trainers can also help but, keep in mind, they usually don’t have the extended training needed to design a good rehab program.

No matter what your ailment, all people should incorporate the different types of exercise that a healthy body needs: cardio, strength work and flexibility moves.

If you have any questions, especially concerning a medical condition, you should consult your doctor and/or rehab specialist such as a certified physical therapist first. To research physical therapists go to www.apta.org, or find a therapist online.

Find all articles by Martica.

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Martica is a Manhattan-based exercise physiologist and nutritionist and an award-winning fitness instructor. She has written for a variety of publications including Self , Health , Prevention , The New York Times and others. Martica is the author of seven books, including her latest, Cross-Training for Dummies . (Read her full bio.)