July 1, 2024 – Low Back pain is a worldwide problem. It is estimated that there are greater than half a billion cases worldwide. Although back pain can have various causes, it is usually the results of a traumatic event.
You probably know the sensation: When you bend over, chances are you’ll experience sudden pain, standing for too long causes stiff pain, and even a small movement can trigger a cramp in your knees.
Although back pain is a really individual condition, there’s one thing that may help almost everyone: walking.
Researchers in Australia report that a every day walk may very well be enough to cut back the likelihood of a return of back pain. Results of a newly published study showed that just 80 to 130 minutes of walking per week – that’s, just 11 to 18 minutes per day – combined with expert pain education could be a cost-effective and easy solution.
The researchers followed the people for as much as six years.
“When we looked at episodes of low back pain that really impact people's lives, we found that the intervention actually reduced relapses by 28%,” said Dr. Natasha Pocovi, study co-author and postdoctoral fellow at Macquarie University in Sydney, Australia.
The study found that walking resulted in 43% fewer doctor visits, she said.
“Under the guidance of the physical therapist, we have actually changed people’s attitudes toward exercise and their views on pain,” she said.
Back pain – a universal problem
“The study showed that recurrent back pain is most often due to an initial injury,” said Elaina Manolis, a physical therapist and assistant professor of clinical medicine at Northeastern University in Boston. “At a muscular level, this changes the composition of the muscles that provide stability to the spine, especially the lower back.”
Targeted exercises reminiscent of walking help prevent muscles from weakening over time, says Manolis, who can be a specialist in geriatrics and orthopedics.
Back pain can have many causes various sourcessaid Dr. Alice Chen, a Stamford, CT-based physiatrist who focuses on non-surgical back pain. Chen can be affiliated with the Hospital For Special Surgery in New York City. “It can be related to muscle spasms, joint irritation in the back, ligaments, back irritation.”
Twenty-five percent of all back pain has no specific cause, she said.
However, research has shown that 40% of those cases are as a consequence of lifestyle aspects – prolonged sitting and being chubby/obese. Yet many interventions and coverings – imaging, prescribed bed rest, steroid injections, painkillers – produce various results. In addition, research shows has shown that these strategies, if not used properly, can delay recovery and, in some cases, increase the chance of long-term disability.
Manolis remembered certainly one of her patients, a person in his late 50s who had been an avid skier and had sustained a back injury on the slopes.
“He was given several injections to help with the pain. He was fine for two or three months, and then he did something minor and the pain got worse. When he started seeing me, we eventually gradually introduced strengthening exercises and walking that helped him overcome his anxiety and get his body moving again,” she said. “By the time I discharged him, he was skiing again and pain free.”
Movement is the important thing
The Australian study not only highlighted the worth of exercise, but in addition highlighted the importance of fear avoidance, that’s, avoiding activities and physical activity for fear of pain.
“Patients often fear their symptoms, that they will last forever, and that they shouldn't move because that will cause further damage to their musculoskeletal system,” says Dr. Ellen McGough, a physical therapist and chair and program director of the Department of Physical Therapy on the University of Rhode Island in Kingston. “But study after study has shown that sedentary activities are worse for back pain; any kind of movement is better,” she explains.
Pocovi said she conducted focus groups with a smaller group of lively individuals who were ultimately not included within the study. They had “lost interest in physical activity because previous episodes (in their eyes) had meant or led to a flare-up of back pain,” she said.
This is where physical therapy, or physiotherapy, could be invaluable. In the study, “the therapist was more like a health coach; educating patients about the pain, reassuring them that they would not cause major harm by participating in a walking program, and also giving people confidence to deal with their problems.”
The results highlighted that over time, the people studied increased the period of time they walked, from 80 minutes in the primary week to 130 minutes in week 12. According to Pocovi, the assistance and support within the early stages of the study ultimately led to the people becoming self-motivated because they might feel the advantages in relieving their back pain and in addition when it comes to improved mood, weight and stress management, and improved sleep.
First steps
When people have back pain, many first consider an orthopedic doctor. But Chen points out that it's vital to think about someone who focuses on physical medicine and rehabilitation.
“In 99 percent of cases, what is needed is not a surgeon, but someone who makes the diagnosis and carries out the treatment,” she said.
“We can often take a history and determine how the patient injured themselves, what movements make the pain worse and what movements make it less painful. This can give us an idea of how to teach them movement patterns, posture and maybe stretches before and after walking,” says McGough.
Manolis says the physical therapist's office can be where people can learn methods to get up their muscles, understand that the occasional twitch or soreness is usually a traditional a part of the healing process (and never necessarily an indication to stop moving), and have conversations about whether one can take steps unexpectedly or spread them out throughout the day.
The same goes for advice on slowly starting a progressive exercise program, be it walking or one other type of physical activity reminiscent of cycling or swimming.
“This is a long-term intervention, not a short-term thing,” says McGough, stressing the importance of helping people recognize potentially misinterpreted muscle tension, muscle fatigue, the correct shoes, etc.
On the patient side, the entire experts we spoke to for this text emphasized the importance of understanding why you’re seeing a health care provider and what you desire to achieve.
“Sometimes the patient wants a diagnosis, sometimes they want reassurance. Most of the time they want pain relief. And more importantly, they want to know how to get back to doing what they want to do,” says Chen, also noting that it's vital to speak what activities they will now not do.
The best all-round tip? If you’ve gotten back pain, get clarity, lose your fear and get moving.