Try This Simple Remedy for Back Pain

Walking gave relief to hundreds of people in a large new study

Liz Szabo,

AARP

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En español

Published July 11, 2024

/ Updated September 06, 2024

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Many people with low back pain stop exercising, fearing that they might make their condition worse.

Researchers hope the results of a new study will change their minds.

People who walked regularly and received educational support reduced their risk of additional episodes of low back pain by 28 percent, according to a new study in The Lancet.

Those results were impressive, given that participants were highly sedentary at the beginning of the study, sitting an average of eight hours a day and walking only an hour a week, said Natasha Pocovi, study author and a postdoctoral fellow in health sciences at Macquarie University in Sydney, Australia.

“We just wanted to get them started,” said Pocovi, a physical therapist. “If they can stick it out initially, their motivation improves, because they start to feel better. People told us, ‘My mental health is better, I’m less stressed, I’m losing weight, I’m better managing my chronic health conditions.’”

Walking is popular among older adults. A 2022 AARP survey found that more than half of adults age 50-plus engage in one or two walking activities in a typical week. A full 86 percent of those walked for 10 minutes or more, and nearly half walked for at least 30 minutes.

Fewer episodes of pain

In the study, researchers randomly assigned half of participants to follow a progressive walking and education program, which involved six visits with a physical therapist over six months. Researchers assigned the other participants to continue their usual activities. Some visits with the physical therapist were in person, while others were virtual.

People assigned to the walking and education program went a median of 208 days without a recurrence of back pain that limited their activities, almost twice as long as the other participants, who suffered a relapse after a median of 112 days. Researchers defined an episode of back pain as one that lasted at least 24 hours, with a pain intensity greater than 2 on a scale of zero to 10, and which at least somewhat interfered with daily activities. Participants had experienced an average of 33 previous episodes of low back pain before beginning the study.

Good for the soul

Charla Fischer, M.D., codirector of NYU Langone Health Orthopedics’ endoscopic spine program, said the study confirms what spine surgeons have been telling their patients for years.

Although many patients who have back surgery are afraid to exercise, Fischer said that starting slowly and cautiously can help people overcome their anxiety.

“I’ll tell patients after surgery to just walk for five minutes,” Fischer said. “It’s not only good for preventing blood clots, but it’s good for the soul.”

Three months into the new study, those assigned to the exercise program walked an average of 6,551 steps a day — 611 more steps than those in the comparison group. Physical therapists tailored their exercise recommendations to each participant, talking to them about their health and what would motivate them to move more. Participants assigned to the walking program were given pedometers to count their steps and asked to keep a walking diary.

Early wins

Physical therapists, who underwent additional training and served as health coaches, checked in regularly with participants, asking if they had completed their walking assignments. That accountability was key, Pocovi said.

“The patients said, ‘Walking is easy, but if you just asked me to go walking, I wouldn’t have done it,’” Pocovi said.

In the beginning, participants were asked to complete as few as two to three 10-minute walks a week, Pocovi said.

“We wanted to get them walking most days for half an hour, but we wanted to make sure we started really low,” Pocovi said. “If you overreach in the first week or two that’s really demotivating,” because people may not be able to keep up or may feel sore.

“You want them to have some early wins,” she said. “People find that much more motivating.”

The study included 701 participants across Australia. More than 80 percent of participants were women, with an average age of 54. Using telehealth allowed researchers to recruit participants in rural areas as well as in towns and cities.

After 12 months, both groups in the study were walking about 160 minutes per week, largely because the comparison group began walking more and caught up their peers in the walking program, Pocovi said. The study took place during the pandemic; it’s possible study participants who weren’t assigned to a special exercise simply began walking — as many people did around the world — because it was one of the few activities in which people could participate during lockdowns.

A remedy for nearly everyone

Low back pain is a leading cause of disability, affecting more than 600 million people, according to the study. Although most people recover from an episode of back pain within a week or two, 70 percent suffer another episode within a year, Pocovi said.

Walking is an inexpensive and relatively low-impact, low-risk activity that almost anyone can do, whether outdoors, on an indoor track or at a mall, Pocovi said. Rates of injury in the study were about the same for those assigned to the walking program and those left on their own, although the people assigned to walk had more injuries to their feet and ankles.

Walking has many known benefits, such as improving cardiovascular health, increasing bone density and helping people maintain a healthy weight.

Getting started

Pocovi said there are lots of way for people to achieve similar results to what participants achieved in the study. She recommends asking doctors to write a referral for a physical therapy visit. If people can’t access physical therapy, they can seek help from a health coach or trainer at a gym.

People who exercise with friends can hold each other accountable, even if they don’t have access to a physical therapist, Pocovi said.

Friends, colleagues or neighbors can arrange to walk at regular times throughout the week — and make sure that everyone shows up.

For those who can’t walk

People who find it painful to walk due to joint pain or other issues can still benefit from other forms of exercise, such as swimming, said Carrie Jaworski, M.D., president-elect of the American College of Sports Medicine.

“Bed rest is not the answer,” Jaworski said. “We need to get people over their fear of movement.”

Both the North American Spine Society and American College of Sports Medicine offer advice on exercises for low back pain. And AARP has “8 Exercises for Lower Back Pain.”

People who can’t swim can opt for water aerobics or walking in the water, Jaworski said.

“Just moving in the water — moving your arms and legs in the water — allows your muscles to relax,” she said. For many kinds of aches and pain, “movement is going to be your best friend.”

Other ways to prevent back pain include stretching and strengthening core muscles — around the pelvis, hips, stomach and lower back — through exercise programs such as yoga, tai chi or Pilates, Jaworski said.

“As we get older, our tendons and ligaments get tighter,” she said. “If someone has incredibly tight hamstrings, they are going to be more prone to back pain.”

Start slowly

When beginning a new exercise routine, Jaworski suggests resting between active days. If people don’t experience an increase in pain, they should aim to increase their exercise by 10 percent week.

“If you do five minutes of walking and your pain is through the roof, then seek medical help,” Pocovi said.

Many people exercise less as they age, often because of concerns about pain or balance, said Colleen Louw, a spokeswoman for the American Physical Therapy Association and program director for the therapeutic pain specialist certification at Evidence in Motion, a postgraduate educational institution for health care professionals.

People who are concerned about their health should see a doctor before beginning a new workout program, Louw said.

“The less you move, the worse your balance will become,” Louw said. “Aging and pain are not correlated; inactivity and pain are correlated.… If you’re not moving, you’re not living.”