Science and Nature news
Lower back pain is one of the leading causes of disability, affecting an estimated 619 million people worldwide. For many people suffering from lower back pain, their condition is cyclical, and their pain returns even after recovery. Nearly 70 percent of people who recover from lower back pain may experience another episode within a year.
Walking could provide these cyclical lower back pain sufferers with an easy, affordable method of relief, researchers recently reported in The Lancet. The new study looked at whether an individualized walking program could prevent the recurrence of lower back pain in patients who had recently recovered from an episode. Patients who started up a regular schedule of walking were less likely to have a recurrence of their lower back pain within a year or longer. For the patients whose lower back pain returned, regular walking seemed to extend the average number of days between episodes.
“The vast majority of research that has been in back pain is looking at treatment of those episodes, but not prevention,” says Mark Hancock, a researcher at Macquarie University in Sydney, Australia, and one of the authors of the study. “We thought it was really important to start focusing on preventing future episodes, and giving patients skills to manage their own back pain, knowing that for most people, this is a fluctuating, long-term condition.”
(The best shoes for back pain)
Aerobic exercise helps
Movement has long been known to help with lower back pain, and the evidence for aerobic exercise as a treatment is exceptionally strong, says Comron Saifi, an orthopedic surgeon at Houston Methodist Hospital, who was not involved in the study. As a result, there are a number of clinical guidelines that recommend light aerobic activity, such as walking, as a strategy for managing episodes of lower back pain.
(Why fitness experts swear by this simple military-inspired exercise)
Despite being a common treatment, walking’s effectiveness in preventing lower back pain is not as well studied. Still, walking offers benefits that already make it a good candidate for prevention. The movement stimulates blood flow to the spine, which helps with healing by increasing the amount of oxygen and nutrients that get carried there. With walking, “The spine is in a position where it is being challenged in a gentle way,” says Femi Betiku, a physical therapist and Pilates instructor based in Westchester, New York, who was not involved in the study. This gentle challenge applies just the right amount of force or load to the spine and has a number of benefits to the muscles and joints of the lower back.
Become a subscriber and support our award-winning editorial features, videos, photography, and more—for as little as $2/mo.
“If you look at walking, there is a really nice, repetitive, but fairly low load going through the spine, and we know that is really great for tissues,” Hancock says. “All tissues in our body respond to loading. They get stronger and healthier with loading.” For the lower back, this includes the muscles that surround and support the spine, as well as the vertebrae and cartilage discs that make up the spine. The gentle impact of walking promotes blood flow to these tissues, while also strengthening the cartilage and bone of the spine. Studies have shown that regular runners have stronger, healthier cartilage discs than non-runners, and walking is thought to have a similar effect.
Walking, along with other forms of light aerobic exercise, also has the effect of helping people move during a time when they may not feel confident in their ability to do so. When people are suffering from an episode of lower back pain, they “start to favor certain positions,” says Kris Gordon, a physical therapist at Washington University in St. Louis, who was not involved in the study. “We become scared to move in certain ways.” Not moving can actually make things worse. Although this feels like the right thing to do in the moment, in the long run, that can cause people to stiffen up, prolonging the episode of pain.
You May Also Like
(Here’s how working long hours can cause lower back pain and other issues in the body.)
In Hancock’s experience as a physical therapist, many patients who suffer from recurring episodes of lower back pain can get to a point where they are afraid to move, even when the pain isn’t there. “There’s this constant sense of ‘When’s it going to come back?’” Hancock says. “I’ve spoken to many patients who haven’t had back pain for a fair while, but they’re still living a really protected life,” out of fear that they may do something to cause a flare-up of their pain. In turn, this can lead to their muscles stiffening up, which can set them up for a recurrence.
Individualized walking program
To get some concrete data on walking and prevention, Hancock and his colleagues recruited 701 people who had recovered from a recent episode of lower back pain that had lasted, on average, 4-5 days, with no discernible cause. To be eligible for the study, participants also had to have no regular exercise program. While the average age for study participants was only 54 years old, those same people had reported an average of 33 episodes of lower back pain in the past.
The team focused on the classic lower back pain patient. “For most people that have back pain, it’s a recurrent, fluctuating condition,” Hancock says. Previous work has shown that these pain episodes tend to last 5-6 days on average.
Researchers sorted patients into two groups. The first group received six sessions with a physical therapist. In these sessions, the goal was to develop an individualized walking program; over the course of six months, each person worked up to walking 30 minutes a day, five days a week. The second group received no treatment.
For the treatment group, therapists adjusted the walking program, depending on the person’s physical limitations and life circumstances. Participants were also given advice on how to manage their pain, in the event that it came back.
Offering individual coaching sessions helped participants find ways to fit walking into their lives, whether it was walking to work or making it a habit to walk at a certain time every day, while also making sure they eased into the program at a pace that was sustainable for their physical abilities. Although the sessions were initially face-to-face, the researchers shifted to telehealth sessions after COVID-19, which allowed them to recruit patients in some very remote areas of Australia where sometimes it’s even hard to get to a primary care doctor.
The approach fits with trends therapists see in clinical settings. “The biggest thing is meeting a patient where they are at,” says Jake Keller, a physical therapist at the University of Rochester Medical Center in New York who was not affiliated with the study.
Participants in both groups reported if and when they had a recurring episode of lower back pain, and the scientists tracked their progress for at least a year and up to three years for some patients.
For the group that received advice on walking, they were 28 percent less likely to report a recurring episode of lower back pain compared to those who had not received treatment. Among all participants whose lower back pain returned, the walking group went an average of 208 days between recurrences, while the group that did no walking reported an average of 112 days between recurrences.
The findings drive home the broader role that movement plays in healing. “Our body heals beautifully, but it needs a good environment to heal, and the healing environment is movement,” Hancock says. “If you move, things feel better.”
