Walking brings huge benefits for low back pain, study finds

NEW YORK, June 19 (UPI) -- Adults with a history of low back pain were able to avoid a recurrence for far longer if they walked regularly compared to those who did not, a new study has found.

The WalkBack study, conducted by Macquarie University's Spinal Pain Research Group in Sydney, Australia, was published Wednesday in The Lancet.

In 2020, low back pain affected 619 million people worldwide, with a projection of 843 million cases by 2050, according to last year's report in Lancet Rheumatology. It's a leading cause of disability and decreased quality of life, experts said.

The current best practice to manage and prevent back pain suggests combining exercise with education. However, many people can't access or afford some types of exercise due to high cost, complexity and need for supervision.

As a result, the Australian researchers decided to examine whether walking could be a helpful, cost-effective, accessible intervention.

For between one and three years, the researchers tracked 701 adults with recent recovery from an episode of low back pain. They randomly assigned participants to an individualized walking program and six physiotherapist-guided education sessions over six months or to a control group.

Their findings could have a profound impact on the management of low back pain, the study's senior author, Mark Hancock , a professor of physiotherapy at Macquarie University, said in a news release.

"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.

"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," he added.

He suggested that walking is highly effective for back pain prevention due to the combination of "gentle oscillatory movements, loading and strengthening the spinal structures and muscles, relaxation and stress relief, and release of 'feel-good' endorphins."

Walking also confers many other benefits to an individual's well-being, such as cardiovascular health, bone density, lower weight and an improved mental state, researchers said.

In addition to providing participants with longer pain-free periods, the program "reduced their need both to seek health care support and the amount of time taken off work by approximately half," Natasha Pocovi , the study's lead author and a postdoctoral fellow in the Department of Health Sciences at Macquarie University, said in a news release.

"There is currently such a heavy focus on treating an episode of low back pain, with much less emphasis on prevention. We expect this study to shift the focus more to prevention," she told UPI via email.

"There is a widespread belief that protecting the back is important and movement can cause harm. We now understand this to simply not be true. Instead, keeping sensibly active within the limits of pain and trying to keep to your usual routine as best possible will result in a quicker recovery."

Previously explored exercise-based interventions to prevent back pain typically were group-based and needed close clinical supervision and expensive equipment, so they were much less accessible to the majority of patients, she noted.

"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.

To expand their research, team members said they hope to explore how to integrate the preventive approach into the routine care of patients experiencing recurrent low back pain.

"This trial represents welcome progress toward improved support for people with recurrent episodes of back pain," United Kingdom-based physiotherapists Diarmuid Denneny and Jackie Walumbe wrote in a commentary that accompanied the study.

"Affordable and accessible interventions that reduce recurrences of back pain and associated social and economic effects are important," the physiotherapists noted.

"Further work evaluating this intervention with broader and diverse populations, where people with comorbidities and those experiencing socioeconomic deprivation are included, is necessary to evaluate real-world application and outcomes," they said.

Dr. Thomas Schuler, chair of the National Spine Health Foundation, said "physical activity, even as simple as a progressive walking program, can be beneficial in preventing the recurrence of low back pain." He was not involved in the study.

"One could apply that same logic to preventing a first episode of low back pain or in the management of low back pain. Sedentary lifestyles are counterproductive to reaching these goals," said Schuler, a spine surgeon and founder of the Virginia Spine Institute in Reston, Va.

These findings align with previous studies revealing that aerobic exercise decreases pain and disability, while improving mental health in patients with back pain, said Dr. D. Scott Kreiner, first vice president on the North American Spine Society's board of directors.

"This study demonstrates that walking alone is enough to decrease the recurrence of back pain episodes and helps physicians direct care," said Kreiner, director of interventional spine and sports medicine at Barrow Brain and Spine in Phoenix.

"The simple recommendation of walking 30 minutes a day, at least five days a week, can help with management of back pain," he said.

If patients have pain, numbness or tingling in the legs, they should seek medical attention. But for those with a simple episode of low back pain that improves over a week or so, beginning a walking program may help prevent future episodes, Kreiner said.

Dr. Peter Whang, an orthopedic spine surgeon at Yale Medicine in New Haven, Conn., said the study's results are "extremely interesting" to him as a practitioner who treats patients with back problems and experiences them himself.

Whang added that "back pain is essentially ubiquitous in our society and a large percentage of individuals will develop recurrent episodes, for which reason this problem is associated with significant human and societal costs."

While many treatments can manage back pain, a therapeutic plan that combines walking and education "is relatively inexpensive and is highly accessible to most people," he said.

"It has the potential to be a very important tool for us to use to address this extremely prevalent condition."

Still, the study "should be interpreted in the context of all the other great research that's out there, as well as applying common sense," said Dr. Michael Walsh, regional chief of neurosurgery at Northwestern University Feinberg School of Medicine in Chicago.

Before people embark on any treatment program, Walsh said, "It's a good idea to consult with a medical professional."