Many years ago I had a friend who, like quite a lot of people, suffered from chronic (long-term) low back pain. Sometimes, his back would ‘flare up’ and incapacitate him for several days at a time. He tried a load of treatments for his back including manipulations and acupuncture. In the end, it was his experience that the thing that made the most difference and kept his back problems largely at bay was a daily walk. In the days that I ran regularly, I would sometimes run past my friend while he enjoyed his daily constitutional. It was ironic that while my friend’s walking seemed to do his back no end of good, my back was invariably sore and stiff after a run to the extent that I was usually unable to bend down to untie my running shoe laces.
I thought about my friend this week while reading about a study in which individuals with back pain were randomised to one of two treatments:
1. back muscle strengthening exercises using specialised equipment
2. walking for 20 – 40 minutes
In both groups, frequency of exercise session was 2-3 times a week, and the whole programme lasted for 6 weeks.
Individuals were assessed in a number of ways before and after the interventions, including a 6-minute walking test (distance covered in 6 minutes of walking), back and abdominal muscle endurance tests, measures of disability and low back pain.
All measures improved significantly in both groups, with no significant difference between the groups (meaning, in essence, that the interventions were equally effective).
Perhaps a couple of years after stopping running (as a result of a seemingly endless stream of running injuries) I began walking regularly and never looked back. I usually plan to incorporate walking within my normal day. For example, I went to dinner last night here in London. I could have changed underground trains and got off at a stop very close to the restaurant. But I elected to take one line on the underground instead, which ‘forced’ me to walk for 20 minutes to the restaurant (and 20 minutes back again on the way home).
One of the great things about walking is that almost all people can do it and have access to this form of activity. Also, no special garb or equipment is required. I do, though, generally make a point of wearing shoes that are rubber soled and comfortable.
References:
1. Shnayderman 1, et al. An aerobic walking programme versus muscle strengthening programme for chronic low back pain: a randomized controlled trial. Clinical Rehabilitation, 2012;27 (3): 207 DOI: 10.1177/0269215512453353
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I can also confirm that eating a paleo / primal style diet including lots of walking has done wonders for my Ankylosing spondylitis too!!! I’ve been off my medication since starting at the beginning of November and never looked back.
Having spent years scouring the internet and books I can finally say I have defied the NHS, as I was told “theres no cure, here take these tablets……… next”.
Well done you, Andrew, and thanks for sharing.
I have to say, I do find paleo/primal approaches to be generally useful in combating ‘autoimmune’ conditions like ankylosing spondylitis.
Dr Briffa,
I see how reducing the pounding on the lower extremities can limit the pain in the lower spine. But, for many chronic sufferers of lower back pain the walking only temporarily abates the symptoms. Sometimes the lack of symptoms gives the patient the false sense of “cure” when in fact the muscular imbalances and abberrant lumbar biomechanic are continuing eventually leading to advanced degenerative changes to the spine and lower extremities. Stuart McGill, PhD believes that many of our LB issues today are related to extensive sitting and the associated atrophy of the gluteal muscles. This idea seems to be supported by many small studies that used minimal amounts of strength exercise to improve balance and ambulation in seniors.
Hi Dr John,
I’m a huge fan of your blog 🙂
I just wanted to mention this book, Treat Your Own Back, by Robin McKenzie – it completely relieved me of lower back pain, which I had suffered for years (I’m a computer programmer so I spend a lot of time sitting at a desk, and I tend to slouch). I had actually made it a lot worse when moving some heavy rocks in my garden one day, which prompted me to do something about it.
http://www.amazon.co.uk/Treat-Your-Back-Robin-McKenzie/dp/0959804927
I wonder how walking levels compare in London compared to other places. I know that I walk everywhere in London since selling my car, and I love it! I know that when I lived in a small town I ended up doing lots of driving…
Matt
Thanks for your kind words. I’ve bought a 2nd hand copy of that book and will take a look.
John
Nobody does backs like McKenzie. A New Zealand icon… should be “Sir Robin”.
Kem – looking forward to reading Sir Robin’s book even more now!
I am the Community Walking Development Officer in Lancashire and we run a range of health walks in the community from 30 minutes – 2.5 hours. I have seen many people benifit from our regular short walks. I am so pleased this has just been published, with all our jobs being under threat at the moment this all goes towards more evidence for walking for health.
Thank you Dr John!
P.S I am also loving Joanne.B’s book What to Eat!
I have significant degenerative disc disease in my back with some scoliosis. My MRI scan looks like a pretzel, yet there is almost nothing that I can’t do. I do posture based exercises, work on my core and frequent long walks. I don’t have much back pain and take no medications.
I was told by a physician years ago that I should have surgery. Fortunately, I ignored his advice.
I have been suffering from lower backpain for a number of years. In April last year I had an epidural block to take care of the pain.To my dismay the relief lasted only one week.Then after the advice of my md I slowly srarted walking.We live in a hilly neighbourhood and walking was agony.When on holiday at the seaside I went for daily walks on the beach without any discomfort.Could you please explain why?
consider “healing back pain” by Dr John Sarno. he has a couple other books too. he’s a back surgeon who has spent a lot of time talking people out of back surgery. his basic premise is that when we don’t deal with our “stuff” we tighten up, particularly creating pressure on the sciatic nerve, but others as well. he argues that the stress of carrying around problems and not acknowledging them is the source of much of our pain. e.g. he critiques the notion that bulging discs cause back pain. the problem is that many people with bulging discs have no pain, and many people with pain have no bulging discs.
anyway, he’s well worth a read, or simply youtube him for interviews.
I had a similar experience and had similar results. I walk 3 miles per day, am pain free, and have a much happier dog.
I used to suffer terrible lower back pain, usually as a result of sailing or rowing in rough sea and found that it was impossible to walk more than half a mile or so before the back pain kicked in again.
I then tried Nordic Walking and it was a revelation! No more pain, making walking a thoroughly enjoyable experience again.
I have no commercial links with any Nordic Walking outfits: just want to point out something that worked for me 🙂
Walking is a wonderful thing, and isn’t just beneficial for backs, in my experience.
I walk every day, to keep my knees working as much as for other benefits… such as keeping my sanity with a little ‘me’ time in a busy life, for getting out into the fresh (well, fresh-ish) air and making the most of the sunshine when we get it, for keeping asthma at bay, and for helping keep my weight within sensible limits.
So, my advice – come rain or shine, get out there and walk 🙂
Regarding Michael’s comment. See my previous post.
I am a Nordic Walking Instructor and we run this as part of our commuity walking programme in Pendle, Lancashire. We have seen many benifits as you say. People with bad knees and bad backs get the help from the poles which if done correctly can drive your forwards. In the later parts of the technique we also encourege slight upper back rotation from the shoulders adding gentle motion to the Thoratic Spine. Once you get over the jokes ‘have you forgot your skiies’ its are very enjoable way to walk.
Walking and minor pains in my lower back
I read the same article as Dr. Briffa a week ago. Suddenly I started to wonder: Why did I no longer have problems putting on my socks in the morning? No big problem, sure. As I am soon turning 67 I thought of this as something that happens to you when you grow older.
I am quite active to be 67: Biking 1-4 hours, running, paragliding, hanggliding. Before skiing and kayaking. Still I had this small back pain.
One month ago I bought a treadmill to use when reading on my Kindle reading board (easier to turn the pages while walking) and while watching TV/DVD-s.
In fact I have been walking very little except for occasional hikes in the mountains carrying a backpack.
I have now almost daily been doing some brisk walking for 60-90 minutes at a speed of 5-6 km an houron my treadmill while doing something I would do sitting before.
I guess that might be the reason why my small lower back pain has disappeared as this is the only thing that has changed during the last month.
I have only just seen Ronelle’s comment. Earthing would explain why you felt without pain walking barefoot on the beach. Living in the middle of a town we earth oursleves by sleeping on an earthing sheet at night. See the book Earthing by Clinton Ober and others http://www.amazon.co.uk/Earthing-Most-Important-Health-Discovery/dp/1591202833/ref=sr_1_1?s=books&ie=UTF8&qid=1363342031&sr=1-1
Searcher’s right – earthing is indeed a potential explanation for your experience, Ronelle.
I’ve written about earthing and my own experience with it here http://www.drbriffa.com/2012/04/18/earthing-important-discovery-or-mumbo-jumbo/.
I used to be a competitive runner in college and for years I jogged but I too started to have a lot of back pain. About 8 years ago I developed a food drop and I was told that I needed back surgery. I declined and started to do posture based exercises outlined in Peter Egoscue’s book “Pain Free”. I also started to walk on a regular basis.
I now have little or no back pain and I can do just about anything. I lift, ski, swim and participate in sports. I more or less “walked away” from surgery and have no regrets.