The treadmill has been used in physiotherapy for over half a century. Advantages of treadmill use include its portability, versatility, and ability to provide low-impact exercise at any time of the day or night. Treadmill running particularly provides an excellent alternative to traditional walking when pain is present in the lower extremities. Disadvantages include hypokinetic muscle activity; therefore, the risk of injury may increase with proper technique maintenance throughout the training period.
Advantages of Treadmill Use for Excercise and Pain Relief
Treadmill use is a very popular alternative to traditional exercise when pain is an issue in the lower extremities. The treadmill provides low-impact, safe running at any time of day. Like a bicycle ergometer, the Best Cushioned Treadmill gives you the ability to measure your heart rate and caloric expenditure based on the speed and inclination of the belt. Most treadmills are also capable of inclining up to 10 percent (10°), which may be difficult to achieve even with outdoor running.
Disadvantages of Treadmill Use for Excercise and Pain Relief
The treadmill is a very dynamic apparatus. All joints must be maintained in proper alignment with each step. Any deviation from the correct technique can lead to injury or an increase in symptoms. Many people using the treadmill for the first time are not adept at maintaining good running mechanics, which increases their risk of injury and provides no stress-relief benefit over traditional walking. In fact, some individuals experience additional pain after treadmill use because they did not warm up properly but rather ran directly on the treadmill without screening for any musculoskeletal problems that would make running inappropriate or unsafe.
Maintaining proper posture while on the treadmill requires you to keep your chin tucked in, shoulders back (to avoid rounded shoulders), knees behind your toes (to avoid knee valgus), and to maintain good pelvic alignment.
Specific Limitations of the Treadmill for People with Arthritis
The treadmill is much more difficult to use for people with arthritis in their lower extremities, which can prevent them from using it at all. People who have difficulty walking or running outdoors may be able to run on the treadmill without experiencing pain that would otherwise prohibit them from exercising outside. The treadmill also allows a person many options when it comes to programming heart rate. It is very common for patients with arthritic knees or hips to walk/run at a pain-free velocity on the treadmill as opposed to jogging outdoors, where they are more likely to experience stress fractures that will require surgery and long recovery.
Modern Treadmill Solutions
Modern treadmills are equipped with programs that help a person maintain good biomechanics when running. If you are having difficulties, ask your therapist to discuss the options available on your specific treadmill. Some of these include:
- Stepping speed
This is the speed at which the belt moves; it can be set to any speed from 0.5 to 6 miles per hour (mph). Walking speeds between 1 and 2 mph are usually considered appropriate for patients with osteoarthritis or other problems affecting gait, as long as they do not increase symptoms. Running speeds should only be used if there is no pain observed during brisk walking on the treadmill. Running may induce more knee joint stress than walking due to knee joint flexion angles and hip flexion angles during the heel strike.
- Running Incline
The treadmill allows for up to 10 percent inclines, which are very beneficial for individuals with knee or hip problems. Jogging at an incline is even more helpful than jogging on a flat surface when it comes to pain relief. Increasing the incline also reduces impact forces, but this should be done incrementally because many people with arthritis have weak knees and hips. If you do not have the strength for a 10 percent incline, start with levels between 1 and 2 percent, and increase it only after you can sustain these lower inclines for at least 20 minutes.
- Step Length
Step length is measured from heel strike to heel strike; most people find that they are comfortable when their step length is about half of their normal gait stride. Keep your chin tucked in, shoulders back (to avoid rounded shoulders), knees behind your toes (to avoid knee valgus), and maintain good pelvic alignment when running on a treadmill. Also, make sure that the speed of the treadmill matches your ability so that you can run with good posture without developing symptoms. If you are having difficulty maintaining good biomechanics, use the handrails to assist you in controlling your posture and stride.
- Rate of Perceived Exertion (RPE)
The treadmill allows for setting a level of intensity that is monitored by a rate of perceived exertion (RPE). For example, if you want to exercise at 60 percent of your maximum heart rate, but do not know what this percentage would feel like, start with an RPE between 11/12 on a scale of 1-20 (no pain to maximal pain), and gradually increase it as tolerated over time. To further customize exercise intensity using RPE, there are many online tools available.
- Cooling fans
These are nice to have during strength training, but they should be turned off while running. A fan blowing on you from behind reduces resistance, which makes running easier. If this occurs while an individual is trying to run outside, it may prevent them from bearing weight on their arthritic joint(s), thereby exacerbating symptoms.
- Water bottles
Some treadmills have reservoirs in front of the console where water bottles can be placed. When inserted into these cups, a water bottle can be used as a counterweight to help with stability and running biomechanics.
A small mirror is sometimes helpful for people who have difficulty gauging their stride length or posture while running; however, it should only be used if you can maintain proper mechanics without it.
- Safety features
Many treadmills now come equipped with safety alerts that will prompt an individual to stop running if they experience pain or significant abnormalities during exercise (usually because of foot drop). Some of these include: o Foot-drop detection systems – These allow you to select which lower extremity joints you would like the treadmill to monitor for foot-drop. If any abnormality is detected, the machine will stop running until this issue is resolved.
- Knee-drop detection system
These work the same way as foot-drop systems, but they measure knee valgus due to patellofemoral pain or instability.
- Handrail use
Handrails can be used when you are starting on the treadmill, and once you have become accustomed to using them, a handrail can help to maintain gait biomechanics by facilitating greater stability.
While there are some disadvantages of treadmill use, its advantages for pain management during exercise are numerous and do not require much effort to realize. I hope that this article has been helpful in expanding your knowledge base of how the treadmill can be used as a tool to help manage symptoms while exercising.