Scientists have uncovered a simple and accessible intervention for lower back pain which they hope will support the more than 600 million people around the world who suffer with this condition.
Chronic and short-term pain in the lower back can affect anyone and is the leading cause of disability worldwide, according to the World Health Organization. Repeated episodes are very common, with 70 percent of those who recover from one seeing a recurrence within a year.
"It's now well-recognized that low back pain is complex, and a range of factors contribute to the development of low back pain, including physical, psychological, social, and lifestyle factors," Natasha Pocovi, a postdoctoral fellow in the Department of Health Sciences at Macquarie University, told Newsweek.
"Often, low back pain occurs when we demand more of our back than the structures (such as muscles, joints, vertebral discs, etc) can tolerate. For example, lifting something too heavy, moving in and out of awkward positions, or remaining in a particular posture for too long. Sometimes low back pain can be caused by direct impact or injury, and very rarely there can be more sinister causes of low back pain, such as a fracture, infection, or cancer."
Previous research has shown that group-based exercise programs, usually with close clinical supervision and use of specialist equipment, can be effective at reducing lower back pain. However, the methods can incur a high cost and may not be accessible to everyone. However, according to research by Pocovi and colleagues at Macquarie University, effective management and prevention can be achieved without spending a dime: by walking.
"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," Mark Hancock, a professor of physiotherapy at Macquarie University and the senior author on the study, said in a statement.
The study followed 701 adults who had recently recovered from an episode of lower back pain. Half the participants were placed on an individualized walking program, plus six physiotherapist-guided education sessions, over a six-month period while the other half were left as a control group. The researchers then followed the participants for between one and three years.
"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," Hancock said.
In other words, participants went nearly twice as long without a recurrence of their back pain if they walked regularly compared to those who did not.
So, why are we seeing these positive associations?
"The benefits of walking could have been from the gentle movements, loading and strengthening of the spinal structures and muscles, the relaxation and stress relief it provides, and the release of feel-good endorphins," said Pocovi, who is the first author on the study. "The education provided by the physiotherapist aimed to give people a better understanding of pain, reduce fear associated with exercise and movement, and give people the confidence to manage their pain."
Walking also comes with a range of other health benefits, such as improved cardiovascular health, bone density, weight control, and improved mental health.
"It's difficult to tease out which of these elements contributed most to preventing low back pain, but it's likely a combination of these," Pocovi said.
You don't need to be walking 20,000 steps a day to see these results, either. "In the trial, the amount of walking each person completed was individualized based on a range of factors, including their age, physical capacity, preferences, and available time," Pocovi said. "We gave them a rough guide of gradually building up to 30 minutes, five times a week.
"After three months, most of the people who took part were walking three to five days a week for an average of 130 minutes per week."
However, walking by itself may not be enough to mitigate against the recurrence of lower back pain. "Pain is complex and can be caused by several factors," Pocovi said. "In terms of lifestyle, we often see low back pain coupled with stress, anxiety, unhealthy habits (such as a sedentary lifestyle, smoking, drinking), obesity, and poor or inadequate sleep. Addressing these may be important for some patients where these are problematic."
Even so, walking offers a simple method for self-managing back pain. "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," Pocovi said.
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