For the first time, researchers have shown how effective a simple walking plan is in recovering from and keeping at bay lower back pain episodes. Until now, this common-sense activity has only thought to have had some benefit.
In a double-blind, randomized clinical trial, scientists from Macquarie University's Spinal Research Group enlisted 701 adults recovering from an episode of lower back pain and assigned them either a simple walking program and six physiotherapy education sessions, or no specific rehabilitation plan.
Patients were followed for between one to three years, depending on enrollment date, and the days until another bout of activity-limiting lower back pain were recorded. What they found was that the walking cohort had an average of nearly eight months between recurring lower back pain episodes, while the control group measured just over three months.
“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, Professor of Physiotherapy at Macquarie University. “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."
Far from a one-size-fits-all approach, the patients' age, body-mass index and current walking level was taken into account when assigned a program, as were other limitations such as comorbidities, environmental barriers to the activity and time constraints. Participants tracked their movement with a pedometer and a walking diary for the first 12 weeks, and had the option to continue doing so for the following 12.
With their individual program, each participant walked five times a week, for at least 30 minutes for each of those days, for six months. During this time, they had six 'health coaching' sessions with back pain specialists that helped the participants understand the science behind the program and build resilience to combat the fear of pain that often discourages people from physical activity.
The researchers found that despite the study being limited to six months, most participants continued their walking program independently for 12 months and beyond.
“We don’t know exactly why walking is so good for preventing back pain, but it is likely to include the combination of the gentle oscillatory movements, loading and strengthening the spinal structures and muscles, relaxation and stress relief, and release of ‘feel-good’ endorphins," said Hancock. “And of course, we also know that walking comes with many other health benefits, including cardiovascular health, bone density, healthy weight, and improved mental health.”
The results of this study could have a significant impact on how lower back pain recovery is handled. While current treatment recommends exercise and education, barriers such as cost, complexity and the need for supervision can prevent many people from receiving adequate help.
“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," said lead author Dr Natasha Pocovi. “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.”
This is positive news for the estimated 800 million people worldwide who suffer form lower back pain, with seven in 10 experiencing recurring bouts of elevated, debilitating pain.
“It not only improved people’s quality of life, but it reduced their need both to seek healthcare support and the amount of time taken off work by approximately half,” Pocovi added.
The study was published in the journal The Lancet.
Source: Macquarie University
