An excellent article in the Journal of Rheumatology published in April 2000  by Edmond discusses the problems of back pain. The authors conclude that there is a high prevalence of back pain in the elderly and therefore physicians and therapists should take note of this and look for means of treating this pain.

To that end, Leinonen, in "Back and Hip Extensor Activities During Trunk Flexion and Extension: Effects on Low Back Pain and Rehabilitation"(Archives of Physical Medicine and Rehabilitation, January 2000), showed that the gluteus maximus muscle was weak in patients with low back pain. This should be taken into consideration when planning your therapeutic exercise program.

Other articles in rehabilitation that we have found important in our clinic discuss the importance of back extensor strength. Arkowski in Archives of Physical Medicine and Rehabilitation, July 1999, showed various exercises that were more effective in activating the paraspinal muscles. These included:

1. Backward and forward rocking in sitting with arms crossed across chest.
2.Trunk rotation with a stick supported behind the head.
3. Shoulder flexion and extension with weights in the hands while on a balance board.
4. Prone extension.
5. Shoulder flexion and extension against resistance in a standing position with the spine in neutral.
6. Walking with an arm swing on a trampoline.

These exercises are easy to use, and I have used them frequently in the clinic for older patients who need back extension strengthening. Since back pain is such a problem in our older population, we need to look for modifications of current exercises that are safe and effective for our older patients.