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SYDNEY — For anyone who has experienced the debilitating effects of low back pain, the results of an eye-opening new study may be a game-changer. Researchers have found that a simple, accessible program of progressive walking and education can significantly reduce the risk of constant low back pain flare-ups in adults. The implications are profound — no longer does managing this pervasive condition require costly equipment or specialized rehab facilities. Instead, putting on a pair of sneakers and taking a daily stroll could be one of the best preventative therapies available.
Australian researchers, publishing their work in The Lancet, recruited over 700 adults across the country who had recently recovered from an episode of non-specific low back pain, which lasted at least 24 hours and interfered with their daily activities. The participants were divided into two groups: one received an individualized walking and education program guided by a physiotherapist over six months, and the other received no treatment at all during the study.
Participants were then carefully followed for at least one year, up to a maximum of nearly three years for some participants. The researchers meticulously tracked any recurrences of low back pain that were severe enough to limit daily activities.
“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,” says lead author Dr. Natasha Pocovi in a media release. “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.”
Methodology: A Step-by-Step Approach
So, what did this potentially back-saving intervention involve? It utilized the principles of health coaching, where physiotherapists worked one-on-one with participants to design and progressively increase a customized walking plan based on the individual's age, fitness level, and objectives.
The process began with a 45-minute consultation to understand each participant's history, conduct an examination, and prescribe an initial “walking dose,” which was then gradually ramped up. The guiding target was to work up to walking at least 30 minutes per day, five times per week, by the six-month mark.
During this period, participants also participated in lessons to help overcome fears about back pain while learning easy strategies to self-manage any recurrences. They were provided with a pedometer and a walking diary to track their progress. After the first 12 weeks, they could choose whether to keep using those motivational tools. Follow-up sessions with the physiotherapist every few weeks, either in-person or via video calls, were focused on monitoring progress, adjusting walking plans when needed, and providing encouragement to keep participants engaged over the long haul.
Results: Dramatic Improvement & A Manageable Approach
The impact of this straightforward intervention was striking. Compared to the control group, participants in the walking program experienced a significantly lower risk of suffering a recurrence of low back pain that limited daily activities. Overall, the risk fell by 28%.
Even more impressive, the average time for a recurrence to strike was nearly double for those in the walking group (208 days) versus the control group (112 days). The results for any recurrence of low back pain, regardless of impact on activities and recurrences requiring medical care, showed similarly promising reductions in risk. Simply put, people engaging in the walking program stayed pain-free for nearly twice as long as others not treating their lower back pain.
Not only were recurrences delayed, but back pain-related disability was also consistently lower among the walking group over the next year. The pedometer data also confirmed that those in the program logged more daily steps and brisk walking times than their counterparts.
Although the program does lead to patient costs for the physiotherapist sessions and pedometers, a review of the economic impact found that the program would still be cost-effective and better than avoiding treatment for debilitating back pain.
“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,” says the paper’s senior author, Macquarie University Professor of Physiotherapy Mark Hancock.
“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.”
Study Limitations
It's important to note that the majority of participants were female and had experienced multiple previous episodes of low back pain, so the results may not be perfectly generalizable across more diverse populations, including those new to back issues. There was also a trend observed of more adverse events related to lower extremity injuries like ankle sprains in the walking group compared to the control group. Still, the researchers emphasized that the total number of adverse events was similar between both groups.
Some participants also started to slow down on their prescribed walking program after peaking around three months, potentially diminishing the effectiveness over time. The authors suggest future studies could explore if the program would be as beneficial with fewer physiotherapist sessions or if led by other providers like exercise physiologists. It also remains unclear if other recreational activities like swimming or cycling could produce comparable benefits.
Takeaways: The Next Steps in Pain Relief
Since the results were so positive, researchers are already advocating to integrate this approach into routine discharge planning for patients recovering from an acute bout of low back pain. For the millions of individuals worldwide who struggle with recurring low back pain, these findings could represent a pivotal shift.
Instead of costly medications or physical therapy sessions, the simple act of walking (and a little help from physiotherapists) may be the key to alleviating a burden that has weighed down so many for far too long.
EdNews Editor Chris Melore contributed to this report.
