Willibald Nagler

Lumbago, which is a problem among young adults and older patients alike, is an acute contraction of the lumbar paraspinal muscles. It has nothing to do with nerve root pressure but can occur when someone is tense, frightened, or has to sit for long periods of time under tension. It is a muscular problem, not to be confused with sciatica, which is a nerve problem. For example, someone who reports pain in the low back and hip probably has sciatica, but if the pain is only in the low back, it is more likely to be lumbago.

Patients with lumbago have lost the natural curve in the lower back; the lower spine will appear completely straight on an x-ray. Lumbago causes a dull (rather than sharp) pain, but in severe cases, people feel like they can't move. The pain is usually worse when sitting.

In this month's column, I'll describe some exercises to relieve the pain of acute lumbago. (See illustrations and instructions below that you can photocopy for your patients.)

Lumbago is a diagnosis of exclusion. Although x-rays and MRI scans may be positive, they are not likely to be helpful for identifying the cause of the pain. The condition is as likely to occur in someone with a desk job, such as working on a computer, as in someone with a manual labor job, such as working on an assembly line.

A medical history may reveal the underlying cause of the lumbago. A slipped or herniated disc could be the source of the pain. Conditions such as osteoarthritis and osteoporosis also can contribute to the onset of lumbago.

The first thing to do, however, is to ease the patient's pain with ice. Application of ice to the low back for 20–30 minutes will temporarily eliminate the ability of sensory nerves to conduct a pain stimulus. Once the acute pain has resolved somewhat, advise the patient to gently perform low back exercises. Although some Web sites and literature recommend the use of heat, I advise patients with lumbago to avoid heating pads; heat will only increase the blood circulation and will not provide much relief.

I recommend that patients apply ice to the injured area for 20 minutes, perform the series of exercises, and then apply the ice for another 20 minutes.

Patients who have difficulty doing the buttocks squeeze should place one hand on each buttock and gently squeeze them together, holding for a few seconds, and then releasing. Eventually, patients will be able to do the exercise without using their hands.

Next month: Exercises to relieve pain caused by whiplash.

Exercises for Acute Lumbago

Buttocks squeeze Lie on your stomach with a pillow under your abdomen. Gently squeeze your buttocks together and release. Repeat 8–10 times.

Side-lying knee-to-chest Placing a pillow under your head, lie on your right side, with knees slightly bent. Slide your left knee up toward your chest, and gently drop it to the floor. Then, gently straighten the leg so both the hip and knee are straight and slightly above right leg. Lower the leg to the floor. Return to starting position. Repeat 6–8 times, then turn over and repeat with your right leg.

Back-lying knee-to-chest Lie on your back with knees bent and feet flat on the floor. Raise your right knee and bring it as close to your chest as possible without straining or using your hands, then return to starting position. Slide the right heel out along the floor until the leg is straight, and gently roll the extended leg from side to side. Return to starting position. Repeat 6–8 times with each leg.

Abdominal strengthening Lie on your back on the floor with arms at your sides and a pillow under your knees. Exhale slowly while lifting your head. Lift only far enough so your shoulder blades are off the floor, then inhale as you lower your head to the floor. Roll it gently from side to side. Repeat 8–10 times.

Lumbago, which is a problem among young adults and older patients alike, is an acute contraction of the lumbar paraspinal muscles. It has nothing to do with nerve root pressure but can occur when someone is tense, frightened, or has to sit for long periods of time under tension. It is a muscular problem, not to be confused with sciatica, which is a nerve problem. For example, someone who reports pain in the low back and hip probably has sciatica, but if the pain is only in the low back, it is more likely to be lumbago.

Patients with lumbago have lost the natural curve in the lower back; the lower spine will appear completely straight on an x-ray. Lumbago causes a dull (rather than sharp) pain, but in severe cases, people feel like they can't move. The pain is usually worse when sitting.

In this month's column, I'll describe some exercises to relieve the pain of acute lumbago. (See illustrations and instructions below that you can photocopy for your patients.)

Lumbago is a diagnosis of exclusion. Although x-rays and MRI scans may be positive, they are not likely to be helpful for identifying the cause of the pain. The condition is as likely to occur in someone with a desk job, such as working on a computer, as in someone with a manual labor job, such as working on an assembly line.

A medical history may reveal the underlying cause of the lumbago. A slipped or herniated disc could be the source of the pain. Conditions such as osteoarthritis and osteoporosis also can contribute to the onset of lumbago.

The first thing to do, however, is to ease the patient's pain with ice. Application of ice to the low back for 20–30 minutes will temporarily eliminate the ability of sensory nerves to conduct a pain stimulus. Once the acute pain has resolved somewhat, advise the patient to gently perform low back exercises. Although some Web sites and literature recommend the use of heat, I advise patients with lumbago to avoid heating pads; heat will only increase the blood circulation and will not provide much relief.

I recommend that patients apply ice to the injured area for 20 minutes, perform the series of exercises, and then apply the ice for another 20 minutes.

Patients who have difficulty doing the buttocks squeeze should place one hand on each buttock and gently squeeze them together, holding for a few seconds, and then releasing. Eventually, patients will be able to do the exercise without using their hands.

Next month: Exercises to relieve pain caused by whiplash.

Exercises for Acute Lumbago

Buttocks squeeze Lie on your stomach with a pillow under your abdomen. Gently squeeze your buttocks together and release. Repeat 8–10 times.

Side-lying knee-to-chest Placing a pillow under your head, lie on your right side, with knees slightly bent. Slide your left knee up toward your chest, and gently drop it to the floor. Then, gently straighten the leg so both the hip and knee are straight and slightly above right leg. Lower the leg to the floor. Return to starting position. Repeat 6–8 times, then turn over and repeat with your right leg.

Back-lying knee-to-chest Lie on your back with knees bent and feet flat on the floor. Raise your right knee and bring it as close to your chest as possible without straining or using your hands, then return to starting position. Slide the right heel out along the floor until the leg is straight, and gently roll the extended leg from side to side. Return to starting position. Repeat 6–8 times with each leg.

Abdominal strengthening Lie on your back on the floor with arms at your sides and a pillow under your knees. Exhale slowly while lifting your head. Lift only far enough so your shoulder blades are off the floor, then inhale as you lower your head to the floor. Roll it gently from side to side. Repeat 8–10 times.

Lumbago, which is a problem among young adults and older patients alike, is an acute contraction of the lumbar paraspinal muscles. It has nothing to do with nerve root pressure but can occur when someone is tense, frightened, or has to sit for long periods of time under tension. It is a muscular problem, not to be confused with sciatica, which is a nerve problem. For example, someone who reports pain in the low back and hip probably has sciatica, but if the pain is only in the low back, it is more likely to be lumbago.

Patients with lumbago have lost the natural curve in the lower back; the lower spine will appear completely straight on an x-ray. Lumbago causes a dull (rather than sharp) pain, but in severe cases, people feel like they can't move. The pain is usually worse when sitting.

In this month's column, I'll describe some exercises to relieve the pain of acute lumbago. (See illustrations and instructions below that you can photocopy for your patients.)

Lumbago is a diagnosis of exclusion. Although x-rays and MRI scans may be positive, they are not likely to be helpful for identifying the cause of the pain. The condition is as likely to occur in someone with a desk job, such as working on a computer, as in someone with a manual labor job, such as working on an assembly line.

A medical history may reveal the underlying cause of the lumbago. A slipped or herniated disc could be the source of the pain. Conditions such as osteoarthritis and osteoporosis also can contribute to the onset of lumbago.

The first thing to do, however, is to ease the patient's pain with ice. Application of ice to the low back for 20–30 minutes will temporarily eliminate the ability of sensory nerves to conduct a pain stimulus. Once the acute pain has resolved somewhat, advise the patient to gently perform low back exercises. Although some Web sites and literature recommend the use of heat, I advise patients with lumbago to avoid heating pads; heat will only increase the blood circulation and will not provide much relief.

I recommend that patients apply ice to the injured area for 20 minutes, perform the series of exercises, and then apply the ice for another 20 minutes.

Patients who have difficulty doing the buttocks squeeze should place one hand on each buttock and gently squeeze them together, holding for a few seconds, and then releasing. Eventually, patients will be able to do the exercise without using their hands.

Next month: Exercises to relieve pain caused by whiplash.

Exercises for Acute Lumbago

Buttocks squeeze Lie on your stomach with a pillow under your abdomen. Gently squeeze your buttocks together and release. Repeat 8–10 times.

Side-lying knee-to-chest Placing a pillow under your head, lie on your right side, with knees slightly bent. Slide your left knee up toward your chest, and gently drop it to the floor. Then, gently straighten the leg so both the hip and knee are straight and slightly above right leg. Lower the leg to the floor. Return to starting position. Repeat 6–8 times, then turn over and repeat with your right leg.

Back-lying knee-to-chest Lie on your back with knees bent and feet flat on the floor. Raise your right knee and bring it as close to your chest as possible without straining or using your hands, then return to starting position. Slide the right heel out along the floor until the leg is straight, and gently roll the extended leg from side to side. Return to starting position. Repeat 6–8 times with each leg.

Abdominal strengthening Lie on your back on the floor with arms at your sides and a pillow under your knees. Exhale slowly while lifting your head. Lift only far enough so your shoulder blades are off the floor, then inhale as you lower your head to the floor. Roll it gently from side to side. Repeat 8–10 times.

Osteoarthritis is the least severe form of arthritis, but it is the most common. In contrast to rheumatoid arthritis, which is a systemic and often chronic condition, osteoarthritis is directly related to activity and age, and it attacks only the joints.

Osteoarthritis may be triggered by many factors that traumatize a joint, but the most common cause is simply the natural wearing away of cartilage in weight-bearing joints that occurs with use over time.

In response to the erosion of cartilage, the body's defense mechanism is to order the growth of new bone. The patches of rough bone, which may become bone spurs, can impede the natural motion of the joint and cause pain.

In addition, a joint affected by osteoarthritis is highly susceptible to flare-ups because the cartilage, having become rough and uneven from the osteoarthritis, is a source of friction for other structures that come into contact with it.

Some patients assume that clicking and cracking noises in the joints mean that they have osteoarthritis. Although such clicking and cracking may be caused by osteoarthritis, it may also be caused by—and is generally aggravated by—tight muscles and tendons, which highlights the importance of maintaining muscle flexibility.

Patients with osteoarthritis often report general good health, except for a particular painful spot. The site of pain is often a large, weight-bearing joint such as the hip or knee, but osteoarthritis can occur in any joint, including those of the feet and hands. The hands—particularly the joints of the fingers—are often affected. About 60% of adults suffer from some osteoarthritic changes in the hands between the ages of 50 and 75 years. The problem usually affects the tips of the fingers—especially the distal interphalangeal joints—and pain may increase when the hands are cold.

Patients suffering from osteoarthritis may notice nodules alongside the finger joints, near the fingertips, or they might find that their hands are stiff first thing in the morning.

Although surgery may be required in extreme cases, most patients can relieve their pain by soaking their hands in warm water for a few minutes when they wake up and by doing daily hand exercises. In addition, patients who suffer from stiffness in their thumbs can rotate the thumb in the largest possible circles in order to improve mobility and maintain the web space between the thumb and first finger. These strategies will help delay disability and maintain function.

Next month: Exercises for patients with acute lumbago.

Osteoarthritis of the Hand

Hand-muscle stretch. Wrap a wide rubber band around your fingers. Spread the fingers apart. Hold for 5 seconds. Relax. Repeat 8 times, working up to 12 times as able. This exercise should not be done when you have an acute flare-up of osteoarthritis in your hand.

The reason for the controlled release is to allow blood to move back into the hand, which is a slower process as we age. This exercise can be done even if there is some swelling in your hands.

Thumb-muscle strengthener. Rotate your hands so the thumbs are facing each other upside-down. Press the thumb of one hand against the thumb of the other hand. Hold for 5 seconds. Relax. Repeat 8-10 times daily to maintain the strength of the thumb muscles. This exercise can be done even if you have some swelling in your hands.

Web-space strengthener. Place both hands together in a steeple shape—thumb to thumb and fingertips to fingertips. Try to press the palms together. You should feel a stretch in the web space between the thumb and index finger, and between the other fingers. Hold for 5 seconds. Relax. Repeat 5-6 times. This exercise can be done even when you have some swelling in your hands.

Osteoarthritis is the least severe form of arthritis, but it is the most common. In contrast to rheumatoid arthritis, which is a systemic and often chronic condition, osteoarthritis is directly related to activity and age, and it attacks only the joints.

Osteoarthritis may be triggered by many factors that traumatize a joint, but the most common cause is simply the natural wearing away of cartilage in weight-bearing joints that occurs with use over time.

In response to the erosion of cartilage, the body's defense mechanism is to order the growth of new bone. The patches of rough bone, which may become bone spurs, can impede the natural motion of the joint and cause pain.

In addition, a joint affected by osteoarthritis is highly susceptible to flare-ups because the cartilage, having become rough and uneven from the osteoarthritis, is a source of friction for other structures that come into contact with it.

Some patients assume that clicking and cracking noises in the joints mean that they have osteoarthritis. Although such clicking and cracking may be caused by osteoarthritis, it may also be caused by—and is generally aggravated by—tight muscles and tendons, which highlights the importance of maintaining muscle flexibility.

Patients with osteoarthritis often report general good health, except for a particular painful spot. The site of pain is often a large, weight-bearing joint such as the hip or knee, but osteoarthritis can occur in any joint, including those of the feet and hands. The hands—particularly the joints of the fingers—are often affected. About 60% of adults suffer from some osteoarthritic changes in the hands between the ages of 50 and 75 years. The problem usually affects the tips of the fingers—especially the distal interphalangeal joints—and pain may increase when the hands are cold.

Patients suffering from osteoarthritis may notice nodules alongside the finger joints, near the fingertips, or they might find that their hands are stiff first thing in the morning.

Although surgery may be required in extreme cases, most patients can relieve their pain by soaking their hands in warm water for a few minutes when they wake up and by doing daily hand exercises. In addition, patients who suffer from stiffness in their thumbs can rotate the thumb in the largest possible circles in order to improve mobility and maintain the web space between the thumb and first finger. These strategies will help delay disability and maintain function.

Next month: Exercises for patients with acute lumbago.

Osteoarthritis of the Hand

Hand-muscle stretch. Wrap a wide rubber band around your fingers. Spread the fingers apart. Hold for 5 seconds. Relax. Repeat 8 times, working up to 12 times as able. This exercise should not be done when you have an acute flare-up of osteoarthritis in your hand.

The reason for the controlled release is to allow blood to move back into the hand, which is a slower process as we age. This exercise can be done even if there is some swelling in your hands.

Thumb-muscle strengthener. Rotate your hands so the thumbs are facing each other upside-down. Press the thumb of one hand against the thumb of the other hand. Hold for 5 seconds. Relax. Repeat 8-10 times daily to maintain the strength of the thumb muscles. This exercise can be done even if you have some swelling in your hands.

Web-space strengthener. Place both hands together in a steeple shape—thumb to thumb and fingertips to fingertips. Try to press the palms together. You should feel a stretch in the web space between the thumb and index finger, and between the other fingers. Hold for 5 seconds. Relax. Repeat 5-6 times. This exercise can be done even when you have some swelling in your hands.

Osteoarthritis is the least severe form of arthritis, but it is the most common. In contrast to rheumatoid arthritis, which is a systemic and often chronic condition, osteoarthritis is directly related to activity and age, and it attacks only the joints.

Osteoarthritis may be triggered by many factors that traumatize a joint, but the most common cause is simply the natural wearing away of cartilage in weight-bearing joints that occurs with use over time.

In response to the erosion of cartilage, the body's defense mechanism is to order the growth of new bone. The patches of rough bone, which may become bone spurs, can impede the natural motion of the joint and cause pain.

In addition, a joint affected by osteoarthritis is highly susceptible to flare-ups because the cartilage, having become rough and uneven from the osteoarthritis, is a source of friction for other structures that come into contact with it.

Some patients assume that clicking and cracking noises in the joints mean that they have osteoarthritis. Although such clicking and cracking may be caused by osteoarthritis, it may also be caused by—and is generally aggravated by—tight muscles and tendons, which highlights the importance of maintaining muscle flexibility.

Patients with osteoarthritis often report general good health, except for a particular painful spot. The site of pain is often a large, weight-bearing joint such as the hip or knee, but osteoarthritis can occur in any joint, including those of the feet and hands. The hands—particularly the joints of the fingers—are often affected. About 60% of adults suffer from some osteoarthritic changes in the hands between the ages of 50 and 75 years. The problem usually affects the tips of the fingers—especially the distal interphalangeal joints—and pain may increase when the hands are cold.

Patients suffering from osteoarthritis may notice nodules alongside the finger joints, near the fingertips, or they might find that their hands are stiff first thing in the morning.

Although surgery may be required in extreme cases, most patients can relieve their pain by soaking their hands in warm water for a few minutes when they wake up and by doing daily hand exercises. In addition, patients who suffer from stiffness in their thumbs can rotate the thumb in the largest possible circles in order to improve mobility and maintain the web space between the thumb and first finger. These strategies will help delay disability and maintain function.

Next month: Exercises for patients with acute lumbago.

Osteoarthritis of the Hand

Hand-muscle stretch. Wrap a wide rubber band around your fingers. Spread the fingers apart. Hold for 5 seconds. Relax. Repeat 8 times, working up to 12 times as able. This exercise should not be done when you have an acute flare-up of osteoarthritis in your hand.

The reason for the controlled release is to allow blood to move back into the hand, which is a slower process as we age. This exercise can be done even if there is some swelling in your hands.

Thumb-muscle strengthener. Rotate your hands so the thumbs are facing each other upside-down. Press the thumb of one hand against the thumb of the other hand. Hold for 5 seconds. Relax. Repeat 8-10 times daily to maintain the strength of the thumb muscles. This exercise can be done even if you have some swelling in your hands.

Web-space strengthener. Place both hands together in a steeple shape—thumb to thumb and fingertips to fingertips. Try to press the palms together. You should feel a stretch in the web space between the thumb and index finger, and between the other fingers. Hold for 5 seconds. Relax. Repeat 5-6 times. This exercise can be done even when you have some swelling in your hands.

Type 2 diabetes is becoming increasingly common in the United States across all ages and ethnicities. This kind of diabetes, which is not dependent on insulin, can be controlled in many people by better attention to exercise and weight management.

Weight control is important for patients with type 2 diabetes, and walking is a safe exercise for most of them.

However, diabetes can predispose patients to aches and pains that can limit their mobility and discourage them from physical activity. In addition to promoting problems such as high blood pressure, type 2 diabetes can affect the nervous system. Consequently, patients may have problems with walking and develop an ungainly gait.

Patients with type 2 diabetes should begin gait exercises as soon as they notice a problem with walking. I recommend that the patient mark the positions of several normal steps on the floor and walk back and forth, stepping on the marks, to improve an awkward, broad-based gait.

An awkward gait can lead to tightness in calves, hamstrings, and hip flexors. Conversely, preexisting tightness in those muscles can contribute to the development of gait problems. Strong and supple hip flexor muscles and adductor muscles are especially helpful for a smooth, efficient gait.

Below are several exercises that patients with type 2 diabetes should do both before and after walking.

Proper footwear will make patients more comfortable, and I recommend athletic socks, preferably those made with moisture-wicking materials, and sneakers with laces that can be easily adjusted as the feet swell.

It is especially important for patients with type 2 diabetes to have well-fitting shoes with a wide toe box, because their nervous system complications may prevent them from feeling foot pain that might be caused by ill-fitting shoes.

I also recommend that patients with type 2 diabetes inspect their feet every day. The patient is his or her own best preventive medicine doctor; once a foot infection occurs, it is difficult to cure.

Patients who sweat excessively can put baby powder inside the socks before walking to help absorb excess moisture and prevent sores.

In addition, remind patients with type 2 diabetes that they must not smoke and that they should work hard to control their weight.

Maintaining a healthy weight will not only help to reduce blood sugar levels; it will also reduce stress on the legs and improve the patient's gait.

Next month: Exercises for patients with osteoarthritis of the hand.

Type 2 Diabetes

▸ Calf stretch. Stand facing a wall about 18 inches away, with your legs and feet together. Lean forward, and place your forearms on the wall, keeping your back flat—not arched or curved—and your heels flat on the floor. This should create a feeling of stretch in the calves. Carefully raise the right knee, placing the right foot over the left knee. You will feel a deeper stretch in the left calf. Start by holding the position for 5 seconds, and work up to 15 seconds. Relax. Repeat with opposite leg. Repeat three to four times.

▸ Adductor stretch. This exercise is for the hip adductor muscles—the often-neglected muscles used to bring the legs together. Sit on a carpeted floor with your legs stretched out into a “V.” Bend your knees and draw your feet in toward your body, bringing the soles of the feet together. Place your hands on your ankles and bend forward while you breathe out, so your elbows rest on the inside of your knees. Slowly and gently press down on your knees with your elbows, creating a feeling of stretch in your inner thighs. Hold the position for 15-30 seconds, depending on your comfort level. Remember to breathe normally. Release and repeat two to three times.

Hip flexor stretch. Lie flat on your back with both knees bent and feet flat on the floor. Raise both knees over your chest. Clasp your hands around your right knee and bring it as close to your chest as possible, sliding the left leg down to the floor. Keep the left leg as flat as possible, and try to touch the back of your left knee to the floor. Hold the stretch for 5-6 seconds, then return to the starting position and relax. Repeat with the opposite leg. Start with three stretches for each leg, and work up to six.

Hamstring stretch. Lie on your back with your arms at your sides, palms down, knees bent, and feet hip-width apart and flat on the floor. Push the small of your back into the floor while bringing your right knee slowly toward your chest while you breathe out. Keep your right foot flexed. Slowly straighten your right leg until the knee is straight. Hold for 15 seconds, and lower the leg down slowly. Relax. Work up to six repetitions. Repeat with the opposite leg.

Type 2 diabetes is becoming increasingly common in the United States across all ages and ethnicities. This kind of diabetes, which is not dependent on insulin, can be controlled in many people by better attention to exercise and weight management.

Weight control is important for patients with type 2 diabetes, and walking is a safe exercise for most of them.

However, diabetes can predispose patients to aches and pains that can limit their mobility and discourage them from physical activity. In addition to promoting problems such as high blood pressure, type 2 diabetes can affect the nervous system. Consequently, patients may have problems with walking and develop an ungainly gait.

Patients with type 2 diabetes should begin gait exercises as soon as they notice a problem with walking. I recommend that the patient mark the positions of several normal steps on the floor and walk back and forth, stepping on the marks, to improve an awkward, broad-based gait.

An awkward gait can lead to tightness in calves, hamstrings, and hip flexors. Conversely, preexisting tightness in those muscles can contribute to the development of gait problems. Strong and supple hip flexor muscles and adductor muscles are especially helpful for a smooth, efficient gait.

Below are several exercises that patients with type 2 diabetes should do both before and after walking.

Proper footwear will make patients more comfortable, and I recommend athletic socks, preferably those made with moisture-wicking materials, and sneakers with laces that can be easily adjusted as the feet swell.

It is especially important for patients with type 2 diabetes to have well-fitting shoes with a wide toe box, because their nervous system complications may prevent them from feeling foot pain that might be caused by ill-fitting shoes.

I also recommend that patients with type 2 diabetes inspect their feet every day. The patient is his or her own best preventive medicine doctor; once a foot infection occurs, it is difficult to cure.

Patients who sweat excessively can put baby powder inside the socks before walking to help absorb excess moisture and prevent sores.

In addition, remind patients with type 2 diabetes that they must not smoke and that they should work hard to control their weight.

Maintaining a healthy weight will not only help to reduce blood sugar levels; it will also reduce stress on the legs and improve the patient's gait.

Next month: Exercises for patients with osteoarthritis of the hand.

Type 2 Diabetes

▸ Calf stretch. Stand facing a wall about 18 inches away, with your legs and feet together. Lean forward, and place your forearms on the wall, keeping your back flat—not arched or curved—and your heels flat on the floor. This should create a feeling of stretch in the calves. Carefully raise the right knee, placing the right foot over the left knee. You will feel a deeper stretch in the left calf. Start by holding the position for 5 seconds, and work up to 15 seconds. Relax. Repeat with opposite leg. Repeat three to four times.

▸ Adductor stretch. This exercise is for the hip adductor muscles—the often-neglected muscles used to bring the legs together. Sit on a carpeted floor with your legs stretched out into a “V.” Bend your knees and draw your feet in toward your body, bringing the soles of the feet together. Place your hands on your ankles and bend forward while you breathe out, so your elbows rest on the inside of your knees. Slowly and gently press down on your knees with your elbows, creating a feeling of stretch in your inner thighs. Hold the position for 15-30 seconds, depending on your comfort level. Remember to breathe normally. Release and repeat two to three times.

Hip flexor stretch. Lie flat on your back with both knees bent and feet flat on the floor. Raise both knees over your chest. Clasp your hands around your right knee and bring it as close to your chest as possible, sliding the left leg down to the floor. Keep the left leg as flat as possible, and try to touch the back of your left knee to the floor. Hold the stretch for 5-6 seconds, then return to the starting position and relax. Repeat with the opposite leg. Start with three stretches for each leg, and work up to six.

Hamstring stretch. Lie on your back with your arms at your sides, palms down, knees bent, and feet hip-width apart and flat on the floor. Push the small of your back into the floor while bringing your right knee slowly toward your chest while you breathe out. Keep your right foot flexed. Slowly straighten your right leg until the knee is straight. Hold for 15 seconds, and lower the leg down slowly. Relax. Work up to six repetitions. Repeat with the opposite leg.

Type 2 diabetes is becoming increasingly common in the United States across all ages and ethnicities. This kind of diabetes, which is not dependent on insulin, can be controlled in many people by better attention to exercise and weight management.

Weight control is important for patients with type 2 diabetes, and walking is a safe exercise for most of them.

However, diabetes can predispose patients to aches and pains that can limit their mobility and discourage them from physical activity. In addition to promoting problems such as high blood pressure, type 2 diabetes can affect the nervous system. Consequently, patients may have problems with walking and develop an ungainly gait.

Patients with type 2 diabetes should begin gait exercises as soon as they notice a problem with walking. I recommend that the patient mark the positions of several normal steps on the floor and walk back and forth, stepping on the marks, to improve an awkward, broad-based gait.

An awkward gait can lead to tightness in calves, hamstrings, and hip flexors. Conversely, preexisting tightness in those muscles can contribute to the development of gait problems. Strong and supple hip flexor muscles and adductor muscles are especially helpful for a smooth, efficient gait.

Below are several exercises that patients with type 2 diabetes should do both before and after walking.

Proper footwear will make patients more comfortable, and I recommend athletic socks, preferably those made with moisture-wicking materials, and sneakers with laces that can be easily adjusted as the feet swell.

It is especially important for patients with type 2 diabetes to have well-fitting shoes with a wide toe box, because their nervous system complications may prevent them from feeling foot pain that might be caused by ill-fitting shoes.

I also recommend that patients with type 2 diabetes inspect their feet every day. The patient is his or her own best preventive medicine doctor; once a foot infection occurs, it is difficult to cure.

Patients who sweat excessively can put baby powder inside the socks before walking to help absorb excess moisture and prevent sores.

In addition, remind patients with type 2 diabetes that they must not smoke and that they should work hard to control their weight.

Maintaining a healthy weight will not only help to reduce blood sugar levels; it will also reduce stress on the legs and improve the patient's gait.

Next month: Exercises for patients with osteoarthritis of the hand.

Type 2 Diabetes

▸ Calf stretch. Stand facing a wall about 18 inches away, with your legs and feet together. Lean forward, and place your forearms on the wall, keeping your back flat—not arched or curved—and your heels flat on the floor. This should create a feeling of stretch in the calves. Carefully raise the right knee, placing the right foot over the left knee. You will feel a deeper stretch in the left calf. Start by holding the position for 5 seconds, and work up to 15 seconds. Relax. Repeat with opposite leg. Repeat three to four times.

▸ Adductor stretch. This exercise is for the hip adductor muscles—the often-neglected muscles used to bring the legs together. Sit on a carpeted floor with your legs stretched out into a “V.” Bend your knees and draw your feet in toward your body, bringing the soles of the feet together. Place your hands on your ankles and bend forward while you breathe out, so your elbows rest on the inside of your knees. Slowly and gently press down on your knees with your elbows, creating a feeling of stretch in your inner thighs. Hold the position for 15-30 seconds, depending on your comfort level. Remember to breathe normally. Release and repeat two to three times.

Hip flexor stretch. Lie flat on your back with both knees bent and feet flat on the floor. Raise both knees over your chest. Clasp your hands around your right knee and bring it as close to your chest as possible, sliding the left leg down to the floor. Keep the left leg as flat as possible, and try to touch the back of your left knee to the floor. Hold the stretch for 5-6 seconds, then return to the starting position and relax. Repeat with the opposite leg. Start with three stretches for each leg, and work up to six.

Hamstring stretch. Lie on your back with your arms at your sides, palms down, knees bent, and feet hip-width apart and flat on the floor. Push the small of your back into the floor while bringing your right knee slowly toward your chest while you breathe out. Keep your right foot flexed. Slowly straighten your right leg until the knee is straight. Hold for 15 seconds, and lower the leg down slowly. Relax. Work up to six repetitions. Repeat with the opposite leg.

Lumbar spinal stenosis occurs in the lower back, where most back movement takes place. The condition develops when osteoarthritis causes a narrowing of the opening in the vertebrae through which the spinal nerves pass. In some advanced cases, bones press on the spinal nerves when the body is in a certain position or positions, which causes a sharp pain.

Symptoms of this condition are similar to those of disk disease; patients may complain of numbness in the legs and pain in the lower spine. Older patients may report shooting pains in the legs when they first wake up in the morning.

Patients with lumbar stenosis may report that walking seems more difficult although they have no apparent pain in their knees. They also may find that their calves hurt after walking but that the calf pain goes away when they sit down. These symptoms are due to a combination of body position and tight muscles that further close off the already narrowed vertebral openings. When the patient sits down, the openings become slightly enlarged, which may reduce the pain temporarily.

Lumbar spinal stenosis is often mistakenly diagnosed as sciatica, peripheral vascular disease, or simply the aches and pains of old age. It tends to develop with age and is more common among people who have worked in a physically demanding job, such as construction, for most of their adult lives. The condition will become more common among the population in general as people live longer.

One way to diagnose lumbar stenosis is a treadmill test, but not the kind you would use for a heart examination. Have the patient walk on a level surface, and then change it to an incline. While walking uphill, patients with spinal stenosis can experience pain relief, but patients with peripheral vascular disease tend to have more severe pain.

In this month's column, we'll look at some exercises to help relieve the discomfort of lumbar spinal stenosis. (See illustrations and instructions for patients below.)

Surgery, although feasible, is difficult and not always successful. Loose hips are important protectors against pain. In addition, strong oblique stomach muscles and strong legs can make patients more comfortable.

Discourage patients with lumbar spinal stenosis from running or walking downhill; this angles the spine in a way that aggravates their pain. Walking on a treadmill on a slight upward incline is a safe activity, however.

Next month: Exercises for patients with type 2 diabetes.

Lumbar Stenosis

Piriformis muscle stretch. The piriformis is a muscle in the hip that often tightens in patients with spinal stenosis. To stretch it, lie on your back with both arms extended at shoulder height. Bring your right foot over your left leg, turning the right knee to the left. Try to keep your trunk and shoulders flat on the floor. Hold for 6 seconds, then return to starting position. Repeat 6-8 times on each side.

Supine paraspinal stretch. Lie on your back on a carpeted floor with legs extended in front of you. Exhale slowly as you lift your head and shoulders and grasp your knees while gently bringing your knees to your chest. Relax. Repeat 6-8 times.

Abdominal strengthening. Lie on your back on a carpeted floor with knees bent and feet flat on the floor. Tuck your chin to your chest, extend your arms, and reach each arm and shoulder across the opposite knee, creating a slight twist. Hold for 6 seconds, then relax. Repeat 6-8 times each side.

Low back extensor. Sit in a chair, with feet flat on the floor and knees shoulder-width apart. Bend forward, and roll the left shoulder toward the right knee, reaching your arms toward your right foot and bringing your head toward the outside of the right knee. Hold for 6 seconds. Contract your abdominal and gluteal muscles as you rise to a seated position. Repeat 4-6 times. Perform on the other side, reaching toward the left knee with the right shoulder. Breathe out as you bend forward. EMILY BRENNAN, ILLUSTRATIONS

Lumbar spinal stenosis occurs in the lower back, where most back movement takes place. The condition develops when osteoarthritis causes a narrowing of the opening in the vertebrae through which the spinal nerves pass. In some advanced cases, bones press on the spinal nerves when the body is in a certain position or positions, which causes a sharp pain.

Symptoms of this condition are similar to those of disk disease; patients may complain of numbness in the legs and pain in the lower spine. Older patients may report shooting pains in the legs when they first wake up in the morning.

Patients with lumbar stenosis may report that walking seems more difficult although they have no apparent pain in their knees. They also may find that their calves hurt after walking but that the calf pain goes away when they sit down. These symptoms are due to a combination of body position and tight muscles that further close off the already narrowed vertebral openings. When the patient sits down, the openings become slightly enlarged, which may reduce the pain temporarily.

Lumbar spinal stenosis is often mistakenly diagnosed as sciatica, peripheral vascular disease, or simply the aches and pains of old age. It tends to develop with age and is more common among people who have worked in a physically demanding job, such as construction, for most of their adult lives. The condition will become more common among the population in general as people live longer.

One way to diagnose lumbar stenosis is a treadmill test, but not the kind you would use for a heart examination. Have the patient walk on a level surface, and then change it to an incline. While walking uphill, patients with spinal stenosis can experience pain relief, but patients with peripheral vascular disease tend to have more severe pain.

In this month's column, we'll look at some exercises to help relieve the discomfort of lumbar spinal stenosis. (See illustrations and instructions for patients below.)

Surgery, although feasible, is difficult and not always successful. Loose hips are important protectors against pain. In addition, strong oblique stomach muscles and strong legs can make patients more comfortable.

Discourage patients with lumbar spinal stenosis from running or walking downhill; this angles the spine in a way that aggravates their pain. Walking on a treadmill on a slight upward incline is a safe activity, however.

Next month: Exercises for patients with type 2 diabetes.

Lumbar Stenosis

Piriformis muscle stretch. The piriformis is a muscle in the hip that often tightens in patients with spinal stenosis. To stretch it, lie on your back with both arms extended at shoulder height. Bring your right foot over your left leg, turning the right knee to the left. Try to keep your trunk and shoulders flat on the floor. Hold for 6 seconds, then return to starting position. Repeat 6-8 times on each side.

Supine paraspinal stretch. Lie on your back on a carpeted floor with legs extended in front of you. Exhale slowly as you lift your head and shoulders and grasp your knees while gently bringing your knees to your chest. Relax. Repeat 6-8 times.

Abdominal strengthening. Lie on your back on a carpeted floor with knees bent and feet flat on the floor. Tuck your chin to your chest, extend your arms, and reach each arm and shoulder across the opposite knee, creating a slight twist. Hold for 6 seconds, then relax. Repeat 6-8 times each side.

Low back extensor. Sit in a chair, with feet flat on the floor and knees shoulder-width apart. Bend forward, and roll the left shoulder toward the right knee, reaching your arms toward your right foot and bringing your head toward the outside of the right knee. Hold for 6 seconds. Contract your abdominal and gluteal muscles as you rise to a seated position. Repeat 4-6 times. Perform on the other side, reaching toward the left knee with the right shoulder. Breathe out as you bend forward. EMILY BRENNAN, ILLUSTRATIONS

Lumbar spinal stenosis occurs in the lower back, where most back movement takes place. The condition develops when osteoarthritis causes a narrowing of the opening in the vertebrae through which the spinal nerves pass. In some advanced cases, bones press on the spinal nerves when the body is in a certain position or positions, which causes a sharp pain.

Symptoms of this condition are similar to those of disk disease; patients may complain of numbness in the legs and pain in the lower spine. Older patients may report shooting pains in the legs when they first wake up in the morning.

Patients with lumbar stenosis may report that walking seems more difficult although they have no apparent pain in their knees. They also may find that their calves hurt after walking but that the calf pain goes away when they sit down. These symptoms are due to a combination of body position and tight muscles that further close off the already narrowed vertebral openings. When the patient sits down, the openings become slightly enlarged, which may reduce the pain temporarily.

Lumbar spinal stenosis is often mistakenly diagnosed as sciatica, peripheral vascular disease, or simply the aches and pains of old age. It tends to develop with age and is more common among people who have worked in a physically demanding job, such as construction, for most of their adult lives. The condition will become more common among the population in general as people live longer.

One way to diagnose lumbar stenosis is a treadmill test, but not the kind you would use for a heart examination. Have the patient walk on a level surface, and then change it to an incline. While walking uphill, patients with spinal stenosis can experience pain relief, but patients with peripheral vascular disease tend to have more severe pain.

In this month's column, we'll look at some exercises to help relieve the discomfort of lumbar spinal stenosis. (See illustrations and instructions for patients below.)

Surgery, although feasible, is difficult and not always successful. Loose hips are important protectors against pain. In addition, strong oblique stomach muscles and strong legs can make patients more comfortable.

Discourage patients with lumbar spinal stenosis from running or walking downhill; this angles the spine in a way that aggravates their pain. Walking on a treadmill on a slight upward incline is a safe activity, however.

Next month: Exercises for patients with type 2 diabetes.

Lumbar Stenosis

Piriformis muscle stretch. The piriformis is a muscle in the hip that often tightens in patients with spinal stenosis. To stretch it, lie on your back with both arms extended at shoulder height. Bring your right foot over your left leg, turning the right knee to the left. Try to keep your trunk and shoulders flat on the floor. Hold for 6 seconds, then return to starting position. Repeat 6-8 times on each side.

Supine paraspinal stretch. Lie on your back on a carpeted floor with legs extended in front of you. Exhale slowly as you lift your head and shoulders and grasp your knees while gently bringing your knees to your chest. Relax. Repeat 6-8 times.

Abdominal strengthening. Lie on your back on a carpeted floor with knees bent and feet flat on the floor. Tuck your chin to your chest, extend your arms, and reach each arm and shoulder across the opposite knee, creating a slight twist. Hold for 6 seconds, then relax. Repeat 6-8 times each side.

Low back extensor. Sit in a chair, with feet flat on the floor and knees shoulder-width apart. Bend forward, and roll the left shoulder toward the right knee, reaching your arms toward your right foot and bringing your head toward the outside of the right knee. Hold for 6 seconds. Contract your abdominal and gluteal muscles as you rise to a seated position. Repeat 4-6 times. Perform on the other side, reaching toward the left knee with the right shoulder. Breathe out as you bend forward. EMILY BRENNAN, ILLUSTRATIONS

Lumbar spinal stenosis occurs in the lower back, where most back movement takes place. The condition develops when osteoarthritis causes a narrowing of the opening in the vertebrae through which the spinal nerves pass. In some advanced cases, bones press on the spinal nerves when the body is in a certain position or positions, which causes a sharp pain.

Symptoms of this condition are similar to those of disk disease; patients may complain of numbness in the legs and pain in the lower spine. Older patients may report shooting pains in the legs when they first wake up in the morning.

Patients with lumbar stenosis may report that walking seems more difficult although they have no apparent pain in their knees. They also may find that their calves hurt after walking but that the calf pain goes away when they sit down. These symptoms are due to a combination of body position and tight muscles that further close off the already narrowed vertebral openings. When the patient sits down, the openings become slightly enlarged, which may reduce the pain temporarily.

Lumbar spinal stenosis is often mistakenly diagnosed as sciatica, peripheral vascular disease, or simply the aches and pains of old age. It tends to develop with age and is more common among people who have worked in a physically demanding job, such as construction, for most of their adult lives. The condition will become more common among the population in general as people live longer.

One way to diagnose lumbar stenosis is a treadmill test, but not the kind you would use for a heart examination. Have the patient walk on a level surface, and then change it to an incline. While walking uphill, patients with spinal stenosis can experience pain relief, but patients with peripheral vascular disease tend to have more severe pain.

In this month's column, we'll look at some exercises to help relieve the discomfort of lumbar spinal stenosis. (See illustrations and instructions for patients below.)

Surgery, although feasible, is difficult and not always successful. Loose hips are important protectors against pain. In addition, strong oblique stomach muscles and strong legs can make patients more comfortable.

Discourage patients with lumbar spinal stenosis from running or walking downhill; this angles the spine in a way that aggravates their pain. Walking on a treadmill on a slight upward incline is a safe activity, however.

Next month: Exercises for patients with type 2 diabetes.

DR. NAGLER is physiatrist-in-chief, emeritus, and professor of rehabilitation medicine at Weill Medical College of Cornell University, New York.

Lumbar Stenosis

Piriformis muscle stretch. The piriformis is a muscle in the hip that often tightens in patients with spinal stenosis. To stretch it, lie on your back with both arms extended at shoulder height. Bring your right foot over your left leg, turning the right knee to the left. Try to keep your trunk and shoulders flat on the floor. Hold for 6 seconds, then return to starting position. Repeat 6-8 times on each side.

Supine paraspinal stretch. Lie on your back on a carpeted floor with legs extended in front of you. Exhale slowly as you lift your head and shoulders and grasp your knees while gently bringing your knees to your chest. Relax. Repeat 6-8 times.

Abdominal strengthening. Lie on your back on a carpeted floor with knees bent and feet flat on the floor. Tuck your chin to your chest, extend your arms, and reach each arm and shoulder across the opposite knee, creating a slight twist. Hold for 6 seconds, then relax. Repeat 6-8 times each side.

Low back extensor. Sit in a chair, with feet flat on the floor and knees shoulder-width apart. Bend forward, and roll the left shoulder toward the right knee, reaching your arms toward your right foot and bringing your head toward the outside of the right knee. Hold for 6 seconds. Contract your abdominal and gluteal muscles as you rise to a seated position. Repeat 4-6 times. Perform on the other side, reaching toward the left knee with the right shoulder. Breathe out as you bend forward. EMILY BRANNAN, ILLUSTRATIONS

Lumbar spinal stenosis occurs in the lower back, where most back movement takes place. The condition develops when osteoarthritis causes a narrowing of the opening in the vertebrae through which the spinal nerves pass. In some advanced cases, bones press on the spinal nerves when the body is in a certain position or positions, which causes a sharp pain.

Symptoms of this condition are similar to those of disk disease; patients may complain of numbness in the legs and pain in the lower spine. Older patients may report shooting pains in the legs when they first wake up in the morning.

Patients with lumbar stenosis may report that walking seems more difficult although they have no apparent pain in their knees. They also may find that their calves hurt after walking but that the calf pain goes away when they sit down. These symptoms are due to a combination of body position and tight muscles that further close off the already narrowed vertebral openings. When the patient sits down, the openings become slightly enlarged, which may reduce the pain temporarily.

Lumbar spinal stenosis is often mistakenly diagnosed as sciatica, peripheral vascular disease, or simply the aches and pains of old age. It tends to develop with age and is more common among people who have worked in a physically demanding job, such as construction, for most of their adult lives. The condition will become more common among the population in general as people live longer.

One way to diagnose lumbar stenosis is a treadmill test, but not the kind you would use for a heart examination. Have the patient walk on a level surface, and then change it to an incline. While walking uphill, patients with spinal stenosis can experience pain relief, but patients with peripheral vascular disease tend to have more severe pain.

In this month's column, we'll look at some exercises to help relieve the discomfort of lumbar spinal stenosis. (See illustrations and instructions for patients below.)

Surgery, although feasible, is difficult and not always successful. Loose hips are important protectors against pain. In addition, strong oblique stomach muscles and strong legs can make patients more comfortable.

Discourage patients with lumbar spinal stenosis from running or walking downhill; this angles the spine in a way that aggravates their pain. Walking on a treadmill on a slight upward incline is a safe activity, however.

Next month: Exercises for patients with type 2 diabetes.

DR. NAGLER is physiatrist-in-chief, emeritus, and professor of rehabilitation medicine at Weill Medical College of Cornell University, New York.

Lumbar Stenosis

Piriformis muscle stretch. The piriformis is a muscle in the hip that often tightens in patients with spinal stenosis. To stretch it, lie on your back with both arms extended at shoulder height. Bring your right foot over your left leg, turning the right knee to the left. Try to keep your trunk and shoulders flat on the floor. Hold for 6 seconds, then return to starting position. Repeat 6-8 times on each side.

Supine paraspinal stretch. Lie on your back on a carpeted floor with legs extended in front of you. Exhale slowly as you lift your head and shoulders and grasp your knees while gently bringing your knees to your chest. Relax. Repeat 6-8 times.

Abdominal strengthening. Lie on your back on a carpeted floor with knees bent and feet flat on the floor. Tuck your chin to your chest, extend your arms, and reach each arm and shoulder across the opposite knee, creating a slight twist. Hold for 6 seconds, then relax. Repeat 6-8 times each side.

Low back extensor. Sit in a chair, with feet flat on the floor and knees shoulder-width apart. Bend forward, and roll the left shoulder toward the right knee, reaching your arms toward your right foot and bringing your head toward the outside of the right knee. Hold for 6 seconds. Contract your abdominal and gluteal muscles as you rise to a seated position. Repeat 4-6 times. Perform on the other side, reaching toward the left knee with the right shoulder. Breathe out as you bend forward. EMILY BRANNAN, ILLUSTRATIONS

Lumbar spinal stenosis occurs in the lower back, where most back movement takes place. The condition develops when osteoarthritis causes a narrowing of the opening in the vertebrae through which the spinal nerves pass. In some advanced cases, bones press on the spinal nerves when the body is in a certain position or positions, which causes a sharp pain.

Symptoms of this condition are similar to those of disk disease; patients may complain of numbness in the legs and pain in the lower spine. Older patients may report shooting pains in the legs when they first wake up in the morning.

Patients with lumbar stenosis may report that walking seems more difficult although they have no apparent pain in their knees. They also may find that their calves hurt after walking but that the calf pain goes away when they sit down. These symptoms are due to a combination of body position and tight muscles that further close off the already narrowed vertebral openings. When the patient sits down, the openings become slightly enlarged, which may reduce the pain temporarily.

Lumbar spinal stenosis is often mistakenly diagnosed as sciatica, peripheral vascular disease, or simply the aches and pains of old age. It tends to develop with age and is more common among people who have worked in a physically demanding job, such as construction, for most of their adult lives. The condition will become more common among the population in general as people live longer.

One way to diagnose lumbar stenosis is a treadmill test, but not the kind you would use for a heart examination. Have the patient walk on a level surface, and then change it to an incline. While walking uphill, patients with spinal stenosis can experience pain relief, but patients with peripheral vascular disease tend to have more severe pain.

In this month's column, we'll look at some exercises to help relieve the discomfort of lumbar spinal stenosis. (See illustrations and instructions for patients below.)

Surgery, although feasible, is difficult and not always successful. Loose hips are important protectors against pain. In addition, strong oblique stomach muscles and strong legs can make patients more comfortable.

Discourage patients with lumbar spinal stenosis from running or walking downhill; this angles the spine in a way that aggravates their pain. Walking on a treadmill on a slight upward incline is a safe activity, however.

Next month: Exercises for patients with type 2 diabetes.

DR. NAGLER is physiatrist-in-chief, emeritus, and professor of rehabilitation medicine at Weill Medical College of Cornell University, New York.

Lumbar Stenosis

Piriformis muscle stretch. The piriformis is a muscle in the hip that often tightens in patients with spinal stenosis. To stretch it, lie on your back with both arms extended at shoulder height. Bring your right foot over your left leg, turning the right knee to the left. Try to keep your trunk and shoulders flat on the floor. Hold for 6 seconds, then return to starting position. Repeat 6-8 times on each side.

Supine paraspinal stretch. Lie on your back on a carpeted floor with legs extended in front of you. Exhale slowly as you lift your head and shoulders and grasp your knees while gently bringing your knees to your chest. Relax. Repeat 6-8 times.

Abdominal strengthening. Lie on your back on a carpeted floor with knees bent and feet flat on the floor. Tuck your chin to your chest, extend your arms, and reach each arm and shoulder across the opposite knee, creating a slight twist. Hold for 6 seconds, then relax. Repeat 6-8 times each side.

Low back extensor. Sit in a chair, with feet flat on the floor and knees shoulder-width apart. Bend forward, and roll the left shoulder toward the right knee, reaching your arms toward your right foot and bringing your head toward the outside of the right knee. Hold for 6 seconds. Contract your abdominal and gluteal muscles as you rise to a seated position. Repeat 4-6 times. Perform on the other side, reaching toward the left knee with the right shoulder. Breathe out as you bend forward. EMILY BRANNAN, ILLUSTRATIONS

A major problem in patients who are rehabilitating after cancer surgery or chemotherapy is that platelet counts go down, and patients develop thrombopenia and bleed easily. In addition, the peripheral nervous system may be impaired, and patients may lose some sensation—they may not feel the floor beneath them when they step down.

Although movement is crucial to prevent muscle wasting in cancer patients, slow is the way to go. Patients should move in ways that avoid trauma, because too much friction can cause bleeding.

To avoid friction, cancer patients should avoid using weights, especially early in recovery. When patients can do 10–12 repetitions of an exercise comfortably, they can add weights, but they should be sure to pad their wrists and ankles before using weights, to reduce the risk of cuts and infections.

In this month's column, we'll look at some exercises for patients recovering from mastectomy or radical prostatectomy. (See illustrations and instructions for patients below.)

Even if they feel weak, patients must get out of bed and take a few steps every day to reduce the risk of atrophy. There are various ways to make this easier.

What we often do is to bring parallel bars right to the bedside, so people can help themselves stand between the bars or take a few steps. Ambulation is extremely important.

If patients are immobile for extended periods of time, the rate of infection is high. It's better to have the patient periodically limping or walking with a walker than sitting or lying down constantly.

Patients should have their thrombocyte (platelet) levels checked before doing exercises. If the thrombocyte levels go up to 100 or 150 million cells per mL of blood volume, then the risk of bleeding is extremely low.

But if the levels are less than 100 million cells per mL, patients should wait until they increase before starting to exercise.

After mastectomy, or even a lumpectomy, patients may suffer from a stiff shoulder, which may evolve into frozen shoulder syndrome if inactivity slows blood flow to the area.

After prostatectomy, the stomach muscles are often weak—which predisposes the patient to low back pain—and the hips are very stiff.

Most men having radical prostatectomy are aged 55 or older and already developing osteoarthritis, so they are especially susceptible to low back pain.

Patients should start stretching as soon as their physician allows, usually 3 weeks after surgery.

Next month: Exercises for lumbar stenosis.

Exercise Rx: After Cancer Surgery

Exercises for patients who have undergone mastectomy/lumpectomy:

▸ Scapular elevation (shoulder circles). Stand or sit in a chair with arms straight down at your sides, and palms facing in. Lift both shoulders slightly, and roll them backward simultaneously. Repeat 10 times. Reverse the motion and roll the shoulders forward. Repeat 10 times.

▸ Horizontal shoulder adduction stretch. Stand or sit in a chair and bring the right arm across the chest, placing it on the left shoulder. Place your left hand on your right elbow and gently pull the arm across the chest. You should feel a stretch in the back of the arm and in the shoulder. Hold for 6 seconds. Relax. Repeat 6 times. Repeat on opposite side.

Exercises for patients who have undergone prostatectomy:

▸ Abdominal strengthening. Lie on your back with a pillow under your knees, and your arms at your sides. Start to exhale slowly while lifting your head, lifting only far enough to see your navel. Exhale slowly while counting to six, then slowly relax to the floor, and gently roll your head from side to side. Repeat 6 times.

▸ Tensor fascia lata (hip) stretch. Lie on your left side on the edge of a bed, facing the middle of the bed. Prop your head up on your left hand. Bend the left leg upward toward the chest. Keeping the top (right) leg straight at the hip and knee, lift it behind your back, and let it dangle over the edge of the bed. Do not arch your back. Hold for 15 seconds. Gently bend the right leg and bring it back up onto the bed. Repeat 6 times with each leg.

A major problem in patients who are rehabilitating after cancer surgery or chemotherapy is that platelet counts go down, and patients develop thrombopenia and bleed easily. In addition, the peripheral nervous system may be impaired, and patients may lose some sensation—they may not feel the floor beneath them when they step down.

Although movement is crucial to prevent muscle wasting in cancer patients, slow is the way to go. Patients should move in ways that avoid trauma, because too much friction can cause bleeding.

To avoid friction, cancer patients should avoid using weights, especially early in recovery. When patients can do 10–12 repetitions of an exercise comfortably, they can add weights, but they should be sure to pad their wrists and ankles before using weights, to reduce the risk of cuts and infections.

In this month's column, we'll look at some exercises for patients recovering from mastectomy or radical prostatectomy. (See illustrations and instructions for patients below.)

Even if they feel weak, patients must get out of bed and take a few steps every day to reduce the risk of atrophy. There are various ways to make this easier.

What we often do is to bring parallel bars right to the bedside, so people can help themselves stand between the bars or take a few steps. Ambulation is extremely important.

If patients are immobile for extended periods of time, the rate of infection is high. It's better to have the patient periodically limping or walking with a walker than sitting or lying down constantly.

Patients should have their thrombocyte (platelet) levels checked before doing exercises. If the thrombocyte levels go up to 100 or 150 million cells per mL of blood volume, then the risk of bleeding is extremely low.

But if the levels are less than 100 million cells per mL, patients should wait until they increase before starting to exercise.

After mastectomy, or even a lumpectomy, patients may suffer from a stiff shoulder, which may evolve into frozen shoulder syndrome if inactivity slows blood flow to the area.

After prostatectomy, the stomach muscles are often weak—which predisposes the patient to low back pain—and the hips are very stiff.

Most men having radical prostatectomy are aged 55 or older and already developing osteoarthritis, so they are especially susceptible to low back pain.

Patients should start stretching as soon as their physician allows, usually 3 weeks after surgery.

Next month: Exercises for lumbar stenosis.

Exercise Rx: After Cancer Surgery

Exercises for patients who have undergone mastectomy/lumpectomy:

▸ Scapular elevation (shoulder circles). Stand or sit in a chair with arms straight down at your sides, and palms facing in. Lift both shoulders slightly, and roll them backward simultaneously. Repeat 10 times. Reverse the motion and roll the shoulders forward. Repeat 10 times.

▸ Horizontal shoulder adduction stretch. Stand or sit in a chair and bring the right arm across the chest, placing it on the left shoulder. Place your left hand on your right elbow and gently pull the arm across the chest. You should feel a stretch in the back of the arm and in the shoulder. Hold for 6 seconds. Relax. Repeat 6 times. Repeat on opposite side.

Exercises for patients who have undergone prostatectomy:

▸ Abdominal strengthening. Lie on your back with a pillow under your knees, and your arms at your sides. Start to exhale slowly while lifting your head, lifting only far enough to see your navel. Exhale slowly while counting to six, then slowly relax to the floor, and gently roll your head from side to side. Repeat 6 times.

▸ Tensor fascia lata (hip) stretch. Lie on your left side on the edge of a bed, facing the middle of the bed. Prop your head up on your left hand. Bend the left leg upward toward the chest. Keeping the top (right) leg straight at the hip and knee, lift it behind your back, and let it dangle over the edge of the bed. Do not arch your back. Hold for 15 seconds. Gently bend the right leg and bring it back up onto the bed. Repeat 6 times with each leg.

A major problem in patients who are rehabilitating after cancer surgery or chemotherapy is that platelet counts go down, and patients develop thrombopenia and bleed easily. In addition, the peripheral nervous system may be impaired, and patients may lose some sensation—they may not feel the floor beneath them when they step down.

Although movement is crucial to prevent muscle wasting in cancer patients, slow is the way to go. Patients should move in ways that avoid trauma, because too much friction can cause bleeding.

To avoid friction, cancer patients should avoid using weights, especially early in recovery. When patients can do 10–12 repetitions of an exercise comfortably, they can add weights, but they should be sure to pad their wrists and ankles before using weights, to reduce the risk of cuts and infections.

In this month's column, we'll look at some exercises for patients recovering from mastectomy or radical prostatectomy. (See illustrations and instructions for patients below.)

Even if they feel weak, patients must get out of bed and take a few steps every day to reduce the risk of atrophy. There are various ways to make this easier.

What we often do is to bring parallel bars right to the bedside, so people can help themselves stand between the bars or take a few steps. Ambulation is extremely important.

If patients are immobile for extended periods of time, the rate of infection is high. It's better to have the patient periodically limping or walking with a walker than sitting or lying down constantly.

Patients should have their thrombocyte (platelet) levels checked before doing exercises. If the thrombocyte levels go up to 100 or 150 million cells per mL of blood volume, then the risk of bleeding is extremely low.

But if the levels are less than 100 million cells per mL, patients should wait until they increase before starting to exercise.

After mastectomy, or even a lumpectomy, patients may suffer from a stiff shoulder, which may evolve into frozen shoulder syndrome if inactivity slows blood flow to the area.

After prostatectomy, the stomach muscles are often weak—which predisposes the patient to low back pain—and the hips are very stiff.

Most men having radical prostatectomy are aged 55 or older and already developing osteoarthritis, so they are especially susceptible to low back pain.

Patients should start stretching as soon as their physician allows, usually 3 weeks after surgery.

Next month: Exercises for lumbar stenosis.

Exercise Rx: After Cancer Surgery

Exercises for patients who have undergone mastectomy/lumpectomy:

▸ Scapular elevation (shoulder circles). Stand or sit in a chair with arms straight down at your sides, and palms facing in. Lift both shoulders slightly, and roll them backward simultaneously. Repeat 10 times. Reverse the motion and roll the shoulders forward. Repeat 10 times.

▸ Horizontal shoulder adduction stretch. Stand or sit in a chair and bring the right arm across the chest, placing it on the left shoulder. Place your left hand on your right elbow and gently pull the arm across the chest. You should feel a stretch in the back of the arm and in the shoulder. Hold for 6 seconds. Relax. Repeat 6 times. Repeat on opposite side.

Exercises for patients who have undergone prostatectomy:

▸ Abdominal strengthening. Lie on your back with a pillow under your knees, and your arms at your sides. Start to exhale slowly while lifting your head, lifting only far enough to see your navel. Exhale slowly while counting to six, then slowly relax to the floor, and gently roll your head from side to side. Repeat 6 times.

▸ Tensor fascia lata (hip) stretch. Lie on your left side on the edge of a bed, facing the middle of the bed. Prop your head up on your left hand. Bend the left leg upward toward the chest. Keeping the top (right) leg straight at the hip and knee, lift it behind your back, and let it dangle over the edge of the bed. Do not arch your back. Hold for 15 seconds. Gently bend the right leg and bring it back up onto the bed. Repeat 6 times with each leg.

The looseness or tightness of the leg and hip muscles can have an enormous impact on knee pain.

The quadriceps and hamstrings maintain about 30% of the knee joint's stability. If a patient complains of knee pain and avoids moving the knee at all, those muscles will atrophy and eventually make the pain worse. There is evidence that people with knee problems who keep the hips loose and maintain strength in the leg muscles—especially the quadriceps—function quite well despite mild knee pain.

In addition, patients who might be candidates for knee replacement surgery can delay it for many years simply by keeping the leg muscles strong and loose. As the population ages, this stands out an important consideration.

Most people aged 60 years and older have some osteoarthritis in their knees, but limber muscles can relieve pain over the long term. These patients should not avoid exercise, but should ease gradually into new activities.

The knee, though primarily a joint with a hingelike action, has the ability to rotate slightly inward, which makes it remarkably versatile but also susceptible to injury. Strong quadriceps muscles help keep the joint in place from the front, while hamstrings do the same from the rear, so it's important to strengthen both sets of muscles using similar amounts of weight.

In this month's column, we'll look at some exercises to help older patients prevent or relieve knee pain. (See illustrations and instructions for patients below.)

Patients who are very sedentary should start without any weights, but if it feels easy, they should begin with very light weights and build up gradually until the last few repetitions of the last set are a bit difficult.

For best results, do this series of exercises daily, 6 days per week, with 1 rest day. Start by doing the exercises twice daily for 2 or 3 weeks, then reduce to once daily, either in the morning or at night, to maintain the knees' natural support system and reduce the risk of injuries. Loosening and strengthening the muscles gradually, over time, also adds to the knees' ability to rebound more quickly if a problem develops.

There are truly no contraindications for these exercises. Knee injuries should not be ignored, but they rarely constitute medical emergencies. Even patients with some swelling in the knee won't make the condition any worse by doing strengthening exercises, and they can, and should, put ice on the knees afterward. Obviously, patients who have extreme or persistent swelling in the knees should use ice to relieve the pain and swelling, keep weight off the knee, and obtain an expert's diagnosis before attempting these exercises.

Next month: Exercises to help recovery after cancer surgery.

Exercise Rx: Knees

Supine leg extensions. Lie on your back on a carpeted floor, arms at your sides, legs straight in front of you. Bend your left leg, placing that foot on the floor. Keeping the right foot cocked upward and flexed, raise the right leg to about 45 degrees. Hold that position for 5 seconds, then slowly lower leg to the floor. Keep the knee of the extended leg in a straight and locked position throughout the exercise, and concentrate on contracting the muscle just above the kneecap. Start with 8-12 repetitions. Switch legs and repeat. Do two sets with each leg. Patients who have been very inactive should do this without weights.

Seated leg extensions. Sit on a straight-backed chair, feet flat on the floor. Place a rolled-up towel under the hamstrings, behind the knees, to keep the chair edge from digging into the back of your leg and to provide traction. Flex the right foot and raise your lower leg until it is parallel with the floor. Hold for 5 seconds and slowly lower down. Repeat 8-12 times. Relax, and repeat with the left leg. Start with two sets, and work up to three sets of 12 repetitions. Be sure your feet are cocked up and pointed slightly outward—not pigeon-toed—to avoid unnecessary strain on the knee joint.

Hip flexor stretches. Tight hips can contribute to knee pain so hip stretches are an important part of knee strengthening. Lie flat on your back on a carpeted floor with both knees bent, feet flat on the floor. Bring your right knee to your chest, wrapping your hands around your lower leg (above the ankle). Slide your left leg out to a straight position, trying to touch the floor with the back of your knee. Hold for 5 seconds, then slowly release both legs back to the starting position. You should feel the stretch on the inner thigh of the extended leg. Repeat 5 times on each leg, working up to 12 repetitions.

Hamstrings. Sit on the edge of a bed with your left foot stretched out on the bed and your right foot on the floor. Flex your left foot and point your toes up. Place your hands on your left knee and bend forward from the hips, keeping your foot cocked up (don't let the leg roll inward or outward). Attempt to grasp your foot with your hands and ease your forehead toward your shin.

The looseness or tightness of the leg and hip muscles can have an enormous impact on knee pain.

The quadriceps and hamstrings maintain about 30% of the knee joint's stability. If a patient complains of knee pain and avoids moving the knee at all, those muscles will atrophy and eventually make the pain worse. There is evidence that people with knee problems who keep the hips loose and maintain strength in the leg muscles—especially the quadriceps—function quite well despite mild knee pain.

In addition, patients who might be candidates for knee replacement surgery can delay it for many years simply by keeping the leg muscles strong and loose. As the population ages, this stands out an important consideration.

Most people aged 60 years and older have some osteoarthritis in their knees, but limber muscles can relieve pain over the long term. These patients should not avoid exercise, but should ease gradually into new activities.

The knee, though primarily a joint with a hingelike action, has the ability to rotate slightly inward, which makes it remarkably versatile but also susceptible to injury. Strong quadriceps muscles help keep the joint in place from the front, while hamstrings do the same from the rear, so it's important to strengthen both sets of muscles using similar amounts of weight.

In this month's column, we'll look at some exercises to help older patients prevent or relieve knee pain. (See illustrations and instructions for patients below.)

Patients who are very sedentary should start without any weights, but if it feels easy, they should begin with very light weights and build up gradually until the last few repetitions of the last set are a bit difficult.

For best results, do this series of exercises daily, 6 days per week, with 1 rest day. Start by doing the exercises twice daily for 2 or 3 weeks, then reduce to once daily, either in the morning or at night, to maintain the knees' natural support system and reduce the risk of injuries. Loosening and strengthening the muscles gradually, over time, also adds to the knees' ability to rebound more quickly if a problem develops.

There are truly no contraindications for these exercises. Knee injuries should not be ignored, but they rarely constitute medical emergencies. Even patients with some swelling in the knee won't make the condition any worse by doing strengthening exercises, and they can, and should, put ice on the knees afterward. Obviously, patients who have extreme or persistent swelling in the knees should use ice to relieve the pain and swelling, keep weight off the knee, and obtain an expert's diagnosis before attempting these exercises.

Next month: Exercises to help recovery after cancer surgery.

Exercise Rx: Knees

Supine leg extensions. Lie on your back on a carpeted floor, arms at your sides, legs straight in front of you. Bend your left leg, placing that foot on the floor. Keeping the right foot cocked upward and flexed, raise the right leg to about 45 degrees. Hold that position for 5 seconds, then slowly lower leg to the floor. Keep the knee of the extended leg in a straight and locked position throughout the exercise, and concentrate on contracting the muscle just above the kneecap. Start with 8-12 repetitions. Switch legs and repeat. Do two sets with each leg. Patients who have been very inactive should do this without weights.

Seated leg extensions. Sit on a straight-backed chair, feet flat on the floor. Place a rolled-up towel under the hamstrings, behind the knees, to keep the chair edge from digging into the back of your leg and to provide traction. Flex the right foot and raise your lower leg until it is parallel with the floor. Hold for 5 seconds and slowly lower down. Repeat 8-12 times. Relax, and repeat with the left leg. Start with two sets, and work up to three sets of 12 repetitions. Be sure your feet are cocked up and pointed slightly outward—not pigeon-toed—to avoid unnecessary strain on the knee joint.

Hip flexor stretches. Tight hips can contribute to knee pain so hip stretches are an important part of knee strengthening. Lie flat on your back on a carpeted floor with both knees bent, feet flat on the floor. Bring your right knee to your chest, wrapping your hands around your lower leg (above the ankle). Slide your left leg out to a straight position, trying to touch the floor with the back of your knee. Hold for 5 seconds, then slowly release both legs back to the starting position. You should feel the stretch on the inner thigh of the extended leg. Repeat 5 times on each leg, working up to 12 repetitions.

Hamstrings. Sit on the edge of a bed with your left foot stretched out on the bed and your right foot on the floor. Flex your left foot and point your toes up. Place your hands on your left knee and bend forward from the hips, keeping your foot cocked up (don't let the leg roll inward or outward). Attempt to grasp your foot with your hands and ease your forehead toward your shin.

The looseness or tightness of the leg and hip muscles can have an enormous impact on knee pain.

The quadriceps and hamstrings maintain about 30% of the knee joint's stability. If a patient complains of knee pain and avoids moving the knee at all, those muscles will atrophy and eventually make the pain worse. There is evidence that people with knee problems who keep the hips loose and maintain strength in the leg muscles—especially the quadriceps—function quite well despite mild knee pain.

In addition, patients who might be candidates for knee replacement surgery can delay it for many years simply by keeping the leg muscles strong and loose. As the population ages, this stands out an important consideration.

Most people aged 60 years and older have some osteoarthritis in their knees, but limber muscles can relieve pain over the long term. These patients should not avoid exercise, but should ease gradually into new activities.

The knee, though primarily a joint with a hingelike action, has the ability to rotate slightly inward, which makes it remarkably versatile but also susceptible to injury. Strong quadriceps muscles help keep the joint in place from the front, while hamstrings do the same from the rear, so it's important to strengthen both sets of muscles using similar amounts of weight.

In this month's column, we'll look at some exercises to help older patients prevent or relieve knee pain. (See illustrations and instructions for patients below.)

Patients who are very sedentary should start without any weights, but if it feels easy, they should begin with very light weights and build up gradually until the last few repetitions of the last set are a bit difficult.

For best results, do this series of exercises daily, 6 days per week, with 1 rest day. Start by doing the exercises twice daily for 2 or 3 weeks, then reduce to once daily, either in the morning or at night, to maintain the knees' natural support system and reduce the risk of injuries. Loosening and strengthening the muscles gradually, over time, also adds to the knees' ability to rebound more quickly if a problem develops.

There are truly no contraindications for these exercises. Knee injuries should not be ignored, but they rarely constitute medical emergencies. Even patients with some swelling in the knee won't make the condition any worse by doing strengthening exercises, and they can, and should, put ice on the knees afterward. Obviously, patients who have extreme or persistent swelling in the knees should use ice to relieve the pain and swelling, keep weight off the knee, and obtain an expert's diagnosis before attempting these exercises.

Next month: Exercises to help recovery after cancer surgery.

Exercise Rx: Knees

Supine leg extensions. Lie on your back on a carpeted floor, arms at your sides, legs straight in front of you. Bend your left leg, placing that foot on the floor. Keeping the right foot cocked upward and flexed, raise the right leg to about 45 degrees. Hold that position for 5 seconds, then slowly lower leg to the floor. Keep the knee of the extended leg in a straight and locked position throughout the exercise, and concentrate on contracting the muscle just above the kneecap. Start with 8-12 repetitions. Switch legs and repeat. Do two sets with each leg. Patients who have been very inactive should do this without weights.

Seated leg extensions. Sit on a straight-backed chair, feet flat on the floor. Place a rolled-up towel under the hamstrings, behind the knees, to keep the chair edge from digging into the back of your leg and to provide traction. Flex the right foot and raise your lower leg until it is parallel with the floor. Hold for 5 seconds and slowly lower down. Repeat 8-12 times. Relax, and repeat with the left leg. Start with two sets, and work up to three sets of 12 repetitions. Be sure your feet are cocked up and pointed slightly outward—not pigeon-toed—to avoid unnecessary strain on the knee joint.

Hip flexor stretches. Tight hips can contribute to knee pain so hip stretches are an important part of knee strengthening. Lie flat on your back on a carpeted floor with both knees bent, feet flat on the floor. Bring your right knee to your chest, wrapping your hands around your lower leg (above the ankle). Slide your left leg out to a straight position, trying to touch the floor with the back of your knee. Hold for 5 seconds, then slowly release both legs back to the starting position. You should feel the stretch on the inner thigh of the extended leg. Repeat 5 times on each leg, working up to 12 repetitions.

Hamstrings. Sit on the edge of a bed with your left foot stretched out on the bed and your right foot on the floor. Flex your left foot and point your toes up. Place your hands on your left knee and bend forward from the hips, keeping your foot cocked up (don't let the leg roll inward or outward). Attempt to grasp your foot with your hands and ease your forehead toward your shin.