July 1, 2024 – Low back pain is a global problem, with estimates suggesting there are more than a half-billion cases worldwide. Although there are various causes of back pain, it often results from a traumatic event.
You probably know the feeling: Bending over may send a shock of pain, standing too long causes a stiff ache, or even just a minor movement can bring a knee-buckling spasm.
While back pain is a very individual condition, there may be one thing that can help most everyone: Walking.
Researchers in Australia report that a daily walk might be all that it takes to reduce the likelihood that back pain returns. Findings from a newly published study showed that walking just 80 to 130 minutes a week – just 11 to 18 minutes a day – plus expert-provided pain education might be a low-cost, easy solution.
Researchers followed people for up to 6 years.
“Looking at episodes of low back pain that really impacts people’s lives, we found that the intervention actually reduced recurrences by 28%,” said Natasha Pocovi, PhD, a study co-author and a postdoctoral research fellow at Macquarie University in Sydney, Australia.
The study found that walking led to 43% fewer trips to see health care professionals, she said.
“We actually changed people’s attitudes towards exercise and their beliefs around pain with guidance from the physical therapist,” she said.
Back Pain a Universal Problem
“The study highlighted that the majority of time, recurrent back pain is due to an initial injury,” said Elaina Manolis, a doctor of physical therapy and assistant clinical professor at Northeastern University in Boston. “What that does at the muscular level is that it actually changes the composition of the muscles that provide stability to the spine, especially the low back.”
Targeted exercise like walking helps prevent those muscles from becoming weaker over time, said Manolis, who's also a board-certified specialist in geriatrics and orthopedics.
Back pain can come from a lot of different sources, said Alice Chen, MD, a Stamford, CT-based physiatrist specializing in non-operative back pain. Chen is also affiliated with the Hospital For Special Surgery In New York City. “It can be related to muscle spasm, joint irritations in the back, ligaments, irritation of the back."
Twenty-five percent of all back pain has no specific origin, she said.
But research has shown that 40% of these cases come from lifestyle factors – prolonged sitting and overweight/obesity. Still, many interventions and treatments – imaging, prescribed bed rest, steroid shots, pain pills – yield varying outcomes. What’s more, research has shown that when they're not used correctly, these strategies can delay recovery and, in some cases, increase the risk of long-term disability.
Manolis remembered one of her patients, a man close to 50 who had been an avid skier and had a back injury on the slopes.
“He had multiple injections to manage the pain, would be good for 2 or 3 months, and then he’d do something minor and flare it up. When he started to see me, we ultimately implemented progressive strengthening and walking, which helped break his fear and get his body moving again,” she said. “By the time I discharged him, he was back to skiing, pain-free.”
Movement is Key
Not only did the Australian study reinforce the value of movement, but it also raised the importance of fear avoidance, meaning avoiding activity and exercise for fear of the pain.
“Patients are often fearful of their symptoms, that they’ll last forever, that they should not move because it will further damage their musculoskeletal structures,” said Ellen McGough, PhD, a physical therapist and chair and program director of the Physical Therapy Department at the University of Rhode Island in Kingston. “But study after study has found that sedentary behavior is worse for low back pain; any type of movement is better,” she explained.
Pocovi said she had done focus groups with a smaller group of active people who were ultimately not included in the study. They had become “disengaged with physical activity because previous episodes had meant or led to (in their minds) a flare-up of low back pain,” she said.
This is where physical therapy or physiotherapy can be invaluable. In the trial, “the therapist was more like a health coach; they provided pain education, reassuring patients that they would not cause more harm by partaking in a walking program, and also giving people self-confidence to self-manage.”
Findings underscored that over time, people being studied increased the time they walked from 80 minutes in the first week to 130 minutes by week 12. According to Pocovi, help and assistance in the early stages of the trial ultimately led to people becoming self-motivated because they were able to feel the benefits for their low back pain and also with regard to improved mood, weight and stress management, and improved sleep.
Getting started
For many people, an orthopedic surgeon is the first person that comes to mind when lower back pain strikes. But Chen noted that it’s important to consider someone who specializes in physical medicine rehabilitation.
“Ninety-nine percent of the time, you don’t need a surgeon; you need someone to diagnose and provide treatment,” she said.
“Many times, we are able to take a history, identify how they got injured, what types of movements make the pain worse, and what types make it better, so we can come up with an idea of how to coach them on how to move, their posture, and maybe stretching activities before and after walking,” said McGough.
According to Manolis, the physical therapist’s office is also where people can learn how to reawaken their muscles, understanding that occasional twitches or pain is often a normal part of the healing process (and not necessarily a sign to stop moving). And it is where conversations about getting steps in all at once or throughout the day can be held.
The same is true for getting advice on how to slowly get into a progressive exercise program, whether it’s walking or some other form of physical activity like cycling or swimming.
“This is a long-term intervention, not a short-term thing,” said McGough, pointing to the importance of helping people identify tight muscles that might be misinterpreted, muscle fatigue, the correct shoes, etc.
On the patient side, all of the experts that we spoke to for this story emphasized the importance of understanding why you are seeing a practitioner and what you hope to achieve.
“Sometimes the patient wants a diagnosis, and sometimes they want reassurance. They want pain relief most of the time. And even more importantly, they want to understand how to get back to what they want to do,” said Chen, also noting that it’s important to share types of activities they are no longer able to do.
The best all-around advice? When it comes to back pain, be clear, lose the fear, and get moving.
