Low back pain affects at least 619 million people worldwide, and that number is expected to increase to 843 million people by 2050, according to research estimates.
Unfortunately, nearly 70% of people who recover from an episode of low back pain have a recurrence within a year, experts say. In addition to acute physical discomfort and lost time at work, treatment often requires education, physical therapy and exercises such as Pilates that may require fees or specialized equipment.
Yet there is an easy, free way to prevent low back pain, at least for a while, according to a new randomized clinical trial.
People in the study who walked regularly after having at least one episode of low back pain were pain free nearly twice as long as those who did not.
“The intervention group had fewer occurrences of activity-limiting pain compared to the control group, and a longer average period before they had a recurrence, with a median of 208 days compared to 112 days,” said senior author Mark Hancock, a professor of physiotherapy at Macquarie University in Sydney.
“Walking is a low-cost, widely accessible and simple exercise that almost anyone can engage in, regardless of geographic location, age or socio-economic status,” Hancock said in a statement.
Walking for at least 30 minutes
The study, published Wednesday in The Lancet journal, followed 701 Australian adults, mostly women in their 50s, who had recently recovered from an episode of low back pain that derailed their ability to perform daily activities. Each person was randomly assigned to a control group with no intervention or an individualized walking and educational program.
Those in the intervention group were asked to build up to 30 minutes of walking five times a week over a six-month period at speeds adjusted for age, physical capacity and individual preferences. Jogging was also allowed.
Participants were asked to wear pedometers to track their daily steps and keep a walking diary. At three months into the program, they also wore an accelerometer that objectively measured daily step count and the amount of brisk walking or other physical activity.
The program also provided six physiotherapist-guided education sessions over six months, a more cost-effective model than typical treatment, Hancock said.
“We included 3 standard sessions with a physiotherapist and 3 brief phone catch ups,” he said in an email. “In the few previous studies of prevention exercise programs for back pain the intervention included approximately 20 group classes.
“We also discussed simple strategies to reduce the risk of a recurrence of low back pain and instructions on how to self-manage any minor recurrences. The education was embedded in the same sessions as the walking prescription.”
Cost-effective intervention
In addition to providing participants with longer pain-free periods, the walking program reduced the amount of time taken off work and medical visits by half, said lead study author Natasha Pocovi, a postdoctoral fellow at Macquarie.
“The exercise-based interventions to prevent back pain that have been explored previously are typically group-based and need close clinical supervision and expensive equipment, so they are much less accessible to the majority of patients,” Pocovi said in a statement.
“Our study has shown that this effective and accessible means of exercise has the potential to be successfully implemented at a much larger scale than other forms of exercise.”
Due to the structure of the study, it was not possible to determine how much of the benefit was due to walking or the educational program provided by physiotherapists, Hancock said.
“We believe it is likely the two components complement each other, with education helping to overcome avoidance and fear of movement, while the health coaching and walking program resulted in behavior change,” he said.
However, because the intervention appeared to be behavioral coaching, and not actual physical therapy, the act of walking may indeed have been the key reason for improvement, said A. Lynn Millar, a retired physical therapist and former professor at Winston-Salem State University in Winston-Salem, North Carolina. She was not involved in the study.
“This is important, as many studies have shown that pain response is partially a behavioral response,” Millar said in an email. “The coaching was limited in duration, thus they can suggest that the primary intervention of walking was the major contributor to the long term response.”
What walking does for the body
What is it about walking that is so helpful for lower back pain? For one, exercise is good for every part of the body.
“First, the person is sitting less, and sitting is not the best posture for the back,” Millar said. “Second, walking will improve general circulation, and will improve blood circulation to the muscles of the back that are actively supporting the individual during the motion. Movement of a joint also helps circulate the joint fluids, thus the joints of the spine may be benefiting from the motion.”
Walking improves metabolism and the amount of calories burned, experts say. Lower weight can ease the load on the back and legs, ensuring better spinal health. Taking a brisk stroll also improves the strength of core muscles around the spine and in the legs, all of which can improve posture and provide better support to the spine.
Walking also increases muscle endurance, assuring muscles are less susceptible to fatigue and injury. Weight-bearing exercises such as walking increase bone density, protecting against injury while stimulating the release of endorphins, the body’s natural feel-good hormones that reduce pain and stress.
When starting a walking program, good shoes and arch supports are necessary, and potential problems may be offset by exercise programs such as resistance training and stretching, Millar said.
“I also think it is important to have varied paces and distances throughout the week. Some problems are caused by progressing too rapidly, and not paying attention to initial aches,” she said.
“I also used to see people that were walking in shoes that did not have good support, or they had become so worn, the support was gone,” she added.
If your “back goes out” during walking, activity modification such as cycling or swimming may be necessary, Millar said. Taking a day or two off from walking and doing some back exercises and stretching can also help.
