Walking and Lower Back Pain, By Mrs Vera West
While no health or medical advice is offered here, in a discussion for information purpose only, it is noted that a mayor peer-reviewed study in the British medical journal, The Lancet https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00755-4/fulltext#seccestitle230 examined whether walking helped people suffering from lower back pain. Lower back pain is a leading cause of disability, leading to billions in medical expenses, along with lost work days. Yet most medical and surgical interventions have limits, with surgery having the risk of the problem reoccurring, and drugs such as non-steroid anti-inflammatory drugs having possible risks of heart attacks and strokes. If something simple and healthy at the same time was available, this would be excellent. Enter walking.
The Australian research team of Macquarie University's Spinal Pain Research Group, had two groups, one with the walking plus education intervention, and the control group with no intervention. According to the lead researcher: "What we could achieve with the intervention group was a 28 percent reduction in recurrences of low back pain that actually limited people's daily activities—not minor recurrences, but ones that impacted people's lives.
"And then even more exciting, I think, is we also looked at recurrences that led to care seeking, and we were able to reduce that by 43 percent."
The short of the long of this is that prolonged bed rest is not the way to go for dealing with low back pain, although rest is still important in cases. What is needed is a balanced approach of gentle exercise, doing what is within one's bounds, without pain. There may be some discomfort at first, but usually that will go once one warms up. And, as well as strengthening the back muscles and supportive structures, walking will improve one's cardiovascular system, the heart and lungs. While other exercises are recommended in the literature, our concern is what can be realistically done by ageing people. Those who are bound to a wheel chair will have special needs, but the lower back may not be such an issue if say the person is paralysed from the waist down.
"In a world-first study, Australian researchers have found the simple activity of walking coupled with education beneficial for those suffering from low back pain.
This comes after a study that was published in the Journal of Physiotherapy found that around seven out of 10 people experience a flare-up of low back pain within 12 months after recovering from an initial episode.
Led by physiotherapist Natasha Pocovi, the WalkBack trial conducted by Macquarie University's Spinal Pain Research Group examined how often low back pain recurred among 701 Aussies who recovered from an episode of non-specific low back pain.
Nonspecific low back pain is the most common form of low back pain that has no specific cause. Low back pain is also a leading cause of disability worldwide.
In the study, participants were randomly allocated to one of two groups. The first group undertook individualised sessions that included six education sessions with a physiotherapist over six months. The second group was the control group, which had no intervention.
The study found that those who undertook the program had 208 pain-free days before a repeat flare-up that required care-seeking, while those in the control group experienced a recurrence of the pain after 112 days. The median days to recurrence were 72 days for the intervention group and 56 days for the control group.
Additionally, those who undertook the WalkBack program had fewer issues with their backs compared to the control group.
"What we found was really quite interesting," Ms. Pocovi told The Epoch Times during a phone call on June 21.
"What we could achieve with the intervention group was a 28 percent reduction in recurrences of low back pain that actually limited people's daily activities—not minor recurrences, but ones that impacted people's lives.
"And then even more exciting, I think, is we also looked at recurrences that led to care seeking, and we were able to reduce that by 43 percent," she said.
What is the WalkBack Program, and How is it Different?Through the WalkBack program, study participants undertook individualised, progressive walking and education sessions with physiotherapists.
The participants completed the program in their own time with the goal of walking five times per week for at least 30 minutes daily for six months.
On average, participants averaged 80 minutes of walking per week in the first week of the program, and by week 12, that average walking time per week was 130 minutes.
Physiotherapists implemented a health coaching approach that involved educating the participant on pain science and how to reduce fear associated with low back pain.
In addition, simple strategies for reducing the risk of recurring low back pain and ways to self-manage minor recurrence were discussed.
Ms. Pocovi said that a common misconception from the public is that pain means more damage.
However, that is not necessarily the case.
"There was quite a bit of time emphasising [to study participants that] you might feel a little bit of discomfort when you first start doing an activity that your body's not used to, but to be aware of it and cautious, starting low in terms of the dosage of the walking, and then very carefully monitoring things moving forward," she said.
"But, pain not meaning damage, was a big one. It also highlights to people that recurrences are common. So I think even just understanding the nature of low back pain, and prefacing gave people awareness and to sensibly manage what their walking program looked like."
The Benefits of Walking for Low Back PainMark Hancock, a professor of physiotherapy at Macquarie University and one of the group leaders in the spinal research group's WalkBack trial, said walking has many benefits for low back pain.
"The loading that's associated with walking—repeated loading and the nice gentle movement that the spine goes through as we walk—is really good for the health of many of the structures in the spine," Mr. Hancock told The Epoch Times during a phone call on June 21.
"We know many tissues, if you think of things like bone, actually respond well to loading. If we don't load them, they become weak. So there's those physical benefits."
Mr. Hancock said that the physiotherapy industry understands how recurrent low back pain is—with repeat flare-ups occurring around two to three times per year for many.
"And in fact, all the evidence suggests that what we should be doing is keeping active," he said.
Moreover, physiotherapists do not recommend cutting off all physical activity after an episode of low back pain.
"Gone are the days we recommend bed rest anymore," Ms. Pocovi said.
"There was a big shift in encouraging people [in the study] to avoid that—that bed rest is not best practice or best care, to really focus on where possible, even if they did have an exacerbation through the WalkBack trial—to remain sensibly active, obviously taper off as needed, but to continue where possible to maintain life as normal if they could."
Importance of Health Coaching and AccountabilityWhile walking is a relatively simple, safe, and cost-effective means of improving low back pain, Ms. Pocovi said the health coaching aspect of the WalkBack trial allowed participants to reap the full benefits of the program.
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In a separate study, Ms. Pocovi and other researchers found that participants in the WalkBack trial reflected positively on clinicians' use of health coaching and adherence to the program, as the trial was designed collaboratively with the participant and accommodated their preferences, functional ability, available time, and lifestyle.
Moreover, participants reported enjoyment and satisfaction with the outcomes, which are essential to long-term exercise adherence.
"The participants used walking to explore their local area, build social networks and establish new hobbies," the study states. "Participants also described that the benefits felt from walking (e.g. improved low back pain, reduced stress, better sleep) were short-lasting."
Ms. Pocovi said that while participants found walking relatively easy, accountability was a key driver of adherence.
"So whether it was a physiotherapist or someone else, that kind of need to be held accountable to at least start a program seemed to be pretty strongly reported amongst the participants," she said.
"The other interesting thing to come out of that qualitative paper was that by the time people got further down the program—and it was already a little bit more habitual and part of daily life, etc.—what kept people compliant and going was the felt benefits. And that's beyond low back pain management, even general health.
"People said they were sleeping better, their mood was improved, they were managing their weight, and they improved management of other chronic health conditions."
Additionally, Ms. Pocovi said participants were reporting that the episodes of low back pain were not as severe or long-lasting if they kept up the walking.
Tips for Walking and Low Back PainWorking in consultation with a physiotherapist or clinician is essential to achieve health goals tailored to your individual needs and circumstances.
Here are some tips for walking and managing low back pain:
- Gradually build up from short to longer walks.
- Mild pain is okay, especially if the body is starting out with a new or adjusted exercise regimen.
- Being accountable to a physiotherapist, clinician, or walking buddy may help keep your goals on track and motivated.
- Stay active even if you may have a recurrence of low back pain. It is okay to reduce the walk time if a recurrence has occurred, but keep going and do not stop."
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