Fitness: You can walk away back pain

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Physical activity is often prescribed to ease low back pain despite the lack of evidence substantiating which type of exercise is the most effective. Is swimming better than cycling? Pilates more effective than yoga?

Most studies compare a small subset of exercise options, which, while narrowing the field, still leaves plenty of ambiguity around an exact prescription. Hence, the difficulty for health and fitness professionals to agree on important details like the ideal exercise volume, intensity and frequency to mitigate discomfort.

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Noting an estimated 80 per cent of the population experiences back pain at least once in their lifetime and 70 per cent face a recurrence within 12 months of their initial episode, an Australian team of health science professionals decided to explore walking as a possible treatment plan. Citing its simplicity, accessibility and low cost, the researchers teamed up with 25 physiotherapy clinics across Australia to deliver individualized walking programs to selected individuals with recurring low back pain.

“Although the health benefits of walking have been widely explored, no trial examined whether walking is effective in preventing recurrence of back pain,” the research team said.

To be eligible, participants had to be recovering from an episode of non-specific back pain that lasted for at least 24 hours and registered at least two on a pain scale of 10 — enough that it interfered with the activities of everyday life. The final cohort consisted of 701 individuals, 351 of which were randomly assigned to a walking group with the remaining 350 acting as controls. Most of the group were women (81 per cent) with an average age of 54. None of the subjects were exercising on a regular basis, including walking.  

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Prior to starting the WalkBack program, the walkers met with a health coach who individualized the program based on their lifestyle, fitness level, access to safe walking routes etc. They were also supplied with a walking diary, pedometer to track their workouts and tips to reduce the risk of recurring back pain. Questionnaires were distributed every month to inquire about any recurrence of back pain as well as the exact day of its onset.

Data from the pedometers and walking diaries revealed the walking group averaged 80 minutes of intentional walking during week one and 130 minutes of walking by week 12.  Most of the study subjects walked three times per week to start and four times by the 12^th week. Their pace picked up, too.

All those steps paid off. It was 208 days before the walkers (who logged 616 more steps per day than the controls) experienced another bout of back pain, compared with 112 days in the control group. The walkers were also less likely than the non-walkers to seek treatment for low back pain.

There was a downside, however. The walking group experienced more lower extremity aches and pains (100) than the controls (54), probably because of the miles logged on their feet. Also notable was adherence to the walking program slowly decreased after the third month, which the researchers believe may be because of a few factors, including the discontinuation of the required walking diary and health coach as well as injuries to the lower body. Yet, despite the initial enthusiasm of the first few months wearing thin, the researchers are pleased with the results.

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“By encouraging active self-management using health coaching principles, the WalkBack intervention might be able to reduce the prevalence of low back pain and associated burden on health-care systems,” the researchers said.

Indeed, the ability to treat low back pain with something as simple as walking is good news for anyone looking for relief. The added bonus of the walking group in this study, however, was the addition of a health coach who was able to personalize the program based on individual limiting factors including fitness, pain and timetable. One strategy that can be adopted by anyone who wants to try managing their low back pain without the aid of a coach is the use of a walking diary. Most smart watches allow users to create training goals, log daily steps, distance and pace. Tracking progress over time helps with long term adherence. So can walking with a buddy, especially if you both log and share stats.

The results are also noteworthy for corporate wellness programs. Investing in a coached walking program available to employees with recurring low back pain can lead to fewer sick days as well as reap all the additional mental and physical health benefits associated with walking. Adding incentives, especially during the first few months of the program, as well as marking significant milestones can boost adherence. So, too, can testimonials from participants and the collection and publishing of stats accumulated by the group. Asking participants to share their walking stats and any recurrence of low back pain is an easy way to track the effectiveness of the program and justify any related costs.

Best of all, walking requires no instruction, can be done solo or in groups, is easy to modify intensity and is low impact, making it stress-free on the joints. In short, it’s an easy, and effective, way to get rid of back pain.

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