How useful is walking for back pain?

Doctors and physical therapists have long incorporated aerobic exercise into treatment programs for low back pain. Movement can relieve lower back pain and at the same time strengthen the muscles that support your back. However, many people with back pain may be reluctant to exercise.

A new study, published Wednesday in The Lancet, offers further evidence about the power of the movement. The study found that regular walking can be very effective in preventing back pain from recurring. The study focused on adults with a history of low back pain; those who walked regularly walked almost twice as long without back pain returning compared to the control group.

The new findings align with a large body of existing research that has established an association between physical activity and better outcomes for back pain. A 2019 systematic review found that physical activity reduced the prevalence of back pain. And a 2017 study found that yoga worked just as well as physical therapy for relieving back pain.

The new study builds on this research by following patients outside of a tightly controlled clinical setting. Mark Hancock, a professor of physiotherapy at Macquarie University in Australia and senior author of the study, sought to evaluate the effectiveness of a less expensive intervention that many people could access more easily than treatment in a clinic.

Dr Hancock and a team of researchers targeted a relatively sedentary sample group. The researchers collected data on 701 adults who had recently recovered from an episode of low back pain. They were randomly divided into two groups: one group received a personalized walking and education program, facilitated by a physiotherapist in six sessions over a six-month period. The other group received no intervention. The researchers followed both groups for the next three years.

The goal for each person in the walking group was to walk five times a week for at least 30 minutes a day, but the program was highly personalized based on age, body mass index, current activity level, limitations of time and personal goals.

Participants in the walking group also received an educational program to help them better understand and respond to their pain. When patients had increased lower back pain, they were encouraged to continue walking, but to adjust speed and distance as needed. Dr Hancock said that when many people experience increased pain, they often feel particularly protective of their back and avoid movement.

“The education changed the way they thought about this topic and made them more active – and to stay active even when they had back pain,” Dr Hancock said.

The new findings also echo the conclusions of a 2020 meta-analysis of 25 studies on low back pain prevention, which Dr. Hancock co-authored. In the meta-analysis, researchers found that regular exercise, combined with physical education, was the most effective way to prevent back pain from recurring.

While there are many different causes of back pain, often the root cause is a “weak base of support,” said Hamza Khalid, MD, a doctor at the Cleveland Clinic Center for Spine Health. Walking can help strengthen muscle groups that help stabilize the spine, primarily the core muscles. Core weakness can lead to fatigue, spinal misalignment and pain, he said.

According to Dr. Hancock's research, nearly 7 in 10 people who recover from an episode of low back pain will experience a recurrence within the following year.

“Exercise is like medicine,” Dr. Khalid said, also stressing that it is “not a magic pill.” If your back pain is chronic or complex, your doctor or physical therapist can help you customize an exercise program to fit your specific needs.

However, moving your body is likely to help. At this point, Dr. Hancock said, “the evidence is quite overwhelming.”

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