What can be done to treat lower back pain?

A new study has highlighted an effective and accessible intervention for adults suffering lower back pain.

Approximately 800 million people worldwide experience lower back pain, and it is a leading cause of disability and reduced quality of life. Repeated episodes of low back pain are also very common, with seven in 10 people who recover from an episode going on to have a recurrence within a year.

However, researchers from Macquarie University have found that adults with a history of lower back pain went nearly twice as long without a recurrence if they walked regularly.

What do the current guidelines recommend?

Current best practice for back pain management and prevention suggests the combination of exercise and education. However, some forms of exercise are not accessible or affordable to many people due to their high cost, complexity and need for supervision.

A clinical trial by Macquarie University’s Spinal Pain Research Group has looked at whether walking could be an effective, cost-effective and accessible intervention.

The trial followed 701 adults who had recently recovered from an episode of low back pain, randomly allocating participants either to an individualised walking program and six physiotherapist-guided education sessions over six months, or to a control group.

Researchers followed the participants for one to three years, depending on when they joined, and the results have now been published in the latest edition of The Lancet. The paper’s senior author, Professor of Physiotherapy Mark Hancock, said the findings could have a profound impact on how lower back pain is managed.

“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,” he said.

Why is walking so effective?

“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,” Hancock said.

“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.

“And of course, we also know that walking comes with many other health benefits, including cardiovascular health, bone density, healthy weight and improved mental health.”

Lead author Dr Natasha Pocovi said in addition to providing participants with longer pain-free periods, the program was very cost-effective.

“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,” she said.

“The exercise-based interventions to prevent back pain that have been explored previously are typically group-based and need close clinical supervision and expensive equipment, so they are much less accessible to the majority of patients.

“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.”

To build on these findings, the team now hopes to explore how they can integrate the preventive approach into the routine care of patients who experience recurrent lower back pain.

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