Effectiveness of an walking intervention for the prevention of low back pain(thelancet.com)
thelancet.com
Effectiveness of an walking intervention for the prevention of low back pain
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00755-4/fulltext
72 comments
Walking helped me but exercises to strengthen the core are what really solved it. Incredible recovery tbh.
which core exercises worked best for you?
Get a kettlebell or two (different weights) and do swings, lots of them. This worked for me.
They can be done any time, indoors or out. It's much more minimalist than a squat rack so I think its a lot easier for most people to start (unless you're already going to a gym frequently or have your own bar).
If you can do ~100 daily with ease, consider a bigger weight.
Example of good form: https://www.youtube.com/watch?v=YSxHifyI6s8&t=1s
They can be done any time, indoors or out. It's much more minimalist than a squat rack so I think its a lot easier for most people to start (unless you're already going to a gym frequently or have your own bar).
If you can do ~100 daily with ease, consider a bigger weight.
Example of good form: https://www.youtube.com/watch?v=YSxHifyI6s8&t=1s
Not OP, but this thread has many anecdotes about what has worked for folks (bodyweight specifically): https://www.reddit.com/r/bodyweightfitness/comments/wcm34h/w...
In my own experience, the three best things for reducing lower back pain were losing weight, squats, and crunches. The weight (~300 lbs to ~240 lbs) of course was the biggest thing to get me from "rarely I can't even stand up from bed easily" to "rarely do I ever get lower back pain".
In my own experience, the three best things for reducing lower back pain were losing weight, squats, and crunches. The weight (~300 lbs to ~240 lbs) of course was the biggest thing to get me from "rarely I can't even stand up from bed easily" to "rarely do I ever get lower back pain".
This is good advice, thanks. I used to get crippling back pain once a year (a cramp that would render me unable to walk for a week) and nothing for the rest of the year.
Now I get low pain all the time, but it's more of the "sore muscle" variety. It does make me walk a bit oddly, at least until I walk it off, but I wish I didn't get that either.
The difference between the two was that i gained weight but started Pilates. I'm losing weight now but I'll start doing squats and crunches as well, thank you.
Now I get low pain all the time, but it's more of the "sore muscle" variety. It does make me walk a bit oddly, at least until I walk it off, but I wish I didn't get that either.
The difference between the two was that i gained weight but started Pilates. I'm losing weight now but I'll start doing squats and crunches as well, thank you.
Be careful with crunches. Depending on the source of your lower back pain, crunches can make the pain worse.
You can give them a try, but definitely stop if you don’t see improvement or if it seems to be getting worse.
You can give them a try, but definitely stop if you don’t see improvement or if it seems to be getting worse.
For me it was squat and deadlift with a lot of stretching.
Though for me a lot of the lower back pain came from really tight hamstrings so the stretching was important for that (and you can't really do squats and deadlifts with proper form without enough flexibility)
Though for me a lot of the lower back pain came from really tight hamstrings so the stretching was important for that (and you can't really do squats and deadlifts with proper form without enough flexibility)
McGill Big three worked for me.
Random link about them:
https://www.womenshealthmag.com/uk/fitness/strength-training...
McGill works with famous weightlifters and athletes which gives him some bro-science cred, he has actual science-science cred but he's also very good on what's actually important for the average aging person.
Highly recommend his back mechanic book.
Random link about them:
https://www.womenshealthmag.com/uk/fitness/strength-training...
McGill works with famous weightlifters and athletes which gives him some bro-science cred, he has actual science-science cred but he's also very good on what's actually important for the average aging person.
Highly recommend his back mechanic book.
Squats and deadlifts are considered the best of all excercises, and will give you a strong, healthy back. Focus in form, not weight, and if you have existing issues find a variation that works for your body (trap bar, Smith machine, different grips and feet placements).
My personal issue with squats and deadlifts is that, if your form is not good, they are more likely to give you back pain.
They are rumored to be really good for you, though.
They are rumored to be really good for you, though.
There are a lot out there but take it easy at first. I started trying to do leg lifts and planks while my back was still hurting, and it only made it a lot worse. Stretching and walking until the pain subsided and then strengthening very slowly is what has worked for me.
See my other post in this thread
Agreed, I tried for years to self motivate to go to the gym/workout at home. Often complaining of back discomfort. I found a personal trainer about a year ago and haven't looked back. So many body ache issues have gone away by strengthening my core, back, etc.
I had bad sciatic nerve pain for a couple of years, finally fixed it with regular 5km walks.
More recently, I would wake up with lower back pain every day. Started running (couch to 5k program), now run 30+ mins 3 times a week and no more back pain.
More recently, I would wake up with lower back pain every day. Started running (couch to 5k program), now run 30+ mins 3 times a week and no more back pain.
About 10 years ago I threw my back out really hard; for about 24 hours I couldn't sit up. After a day or two I could get up but was walking with a cane for a few days. For the next month I had constant pain. Before I'd thrown out my back I had been running 3-4 times a week; obviously after such an injury I wanted to wait for it to heal before I started up again. After a month, I decided to just do a short easy run and see how it went.
After the run, as I was recovering, I noticed that for the first time in a month I was pain-free. For the next month, every time my back started to hurt a bit, I went for a run and the pain went away.
Obviously everyone's situation is different, and I'm sure there are cases where running would be a terrible idea. But exercise should definitely one of the tools you consider trying out when you have an issue like this.
After the run, as I was recovering, I noticed that for the first time in a month I was pain-free. For the next month, every time my back started to hurt a bit, I went for a run and the pain went away.
Obviously everyone's situation is different, and I'm sure there are cases where running would be a terrible idea. But exercise should definitely one of the tools you consider trying out when you have an issue like this.
>I had bad sciatic nerve pain for a couple of years, finally fixed it with regular 5km walks.
Out of curiosity, have you sought any physiotherapy for it beforehand? For me, walking is really good for unwinding mentally and burning calories, but fixing posture and back pain requires to train those specific body parts that are too weak to support the spine correctly, or too tight pulling the spine in the wrong position, and that usually requires a specialist to monitor your posture and tightness and prescribe certain exercises tailored to your deficiencies.
Out of curiosity, have you sought any physiotherapy for it beforehand? For me, walking is really good for unwinding mentally and burning calories, but fixing posture and back pain requires to train those specific body parts that are too weak to support the spine correctly, or too tight pulling the spine in the wrong position, and that usually requires a specialist to monitor your posture and tightness and prescribe certain exercises tailored to your deficiencies.
Just massage, which would take the pain away for a few hours at best.
I went to a physio about my bad back once and she put ‘magic sticky tape’ on my back and not much else. Didn’t bother returning and thankfully the running was the answer.
I went to a physio about my bad back once and she put ‘magic sticky tape’ on my back and not much else. Didn’t bother returning and thankfully the running was the answer.
I had disc herniation and my mother, who is a retired doctor, said to just do a lot of fast walking. This is the only activity I could do anyways after running marathons just months before. So 10 to 21.1 km walks helped a lot.
I also did some own research. The disks tissue has no blood vessels and the only way to get nutrients is via diffusion, so any activity is essential to accelerate the diffusion and recovery. Walking puts gentle axial load on the spine and knees and is simple and more accessible than e.g. swimming, which is probably even more gentle but hard to do daily for an hour.
I also did some own research. The disks tissue has no blood vessels and the only way to get nutrients is via diffusion, so any activity is essential to accelerate the diffusion and recovery. Walking puts gentle axial load on the spine and knees and is simple and more accessible than e.g. swimming, which is probably even more gentle but hard to do daily for an hour.
This explains a lot about the study. Is the study, normal steps didn’t increase that much, on a percentage basis, but “brisk steps” nearly doubled.
> I had disc herniation and my mother, who is a retired doctor, said to just do a lot of fast walking.
Anecdotally slow walking makes my sciatica worse and fast walking alleviates any pain in minutes.
Did your mother, or your research, point to any reasons why fast walking in particular?
My working theory for my body in particular is that I'm more on my toes with less heel impact but I couldn't find anything other than anecdotes here. Also light skipping on my toes helps in a similar matter in a pinch.
Anecdotally slow walking makes my sciatica worse and fast walking alleviates any pain in minutes.
Did your mother, or your research, point to any reasons why fast walking in particular?
My working theory for my body in particular is that I'm more on my toes with less heel impact but I couldn't find anything other than anecdotes here. Also light skipping on my toes helps in a similar matter in a pinch.
My explanation/understanding is that fast walking with larger strides creates rotational movement around the spine axis and that stimulates the tissue. With slow walking, one could do that with no body rotation and only the legs move.
Hmm, there might be something to that. Thanks
I'll experiment with it and try to isolate it. The description reminds me of twisting but twisting is often associated with more pain. However there are some videos that suggest similar movements relieve symptoms. This one[1] seems quite popular.
[1] - https://www.youtube.com/watch?v=vMP1lYEJAko
I'll experiment with it and try to isolate it. The description reminds me of twisting but twisting is often associated with more pain. However there are some videos that suggest similar movements relieve symptoms. This one[1] seems quite popular.
[1] - https://www.youtube.com/watch?v=vMP1lYEJAko
Not a native English speaker.
Is it correct "an walking intervention"? Should it be "a walking..."?
Original title is "Effectiveness and cost-effectiveness of an individualised, progressive walking and education intervention for the prevention of low back pain recurrence in Australia (WalkBack): a randomised controlled trial", which was probably shortened to accomodate the character limit, but the submitter forgot to update the indefinite article.
That's correct. The general rule is to use "an" before a vowel sound, and "a" before a consonant sound. This gets a little fuzzy with acronyms that have several valid pronunciations, but "walking" clearly starts with a consonant sound in this case.
It might not be so clear for a nonnative speaker, since "walking" sounds very similar to "ooalking".
Native English speaker here. "A" is the correct article before the word "walking".
As a non-native i thought that op meant is it correct to use "walking intervention" instead of just "walking".
Someone shortened the original title, removing a word after “an” which had caused the need for “an” rather than “a”.
In other words, the title was shortened incorrectly.
In other words, the title was shortened incorrectly.
Just to save folks a click, the original title contained "... an individualised, progressive walking and education intervention ...".
More or less the rule is "an" before vowels or voiceless H.
eg.
An apple.
A banana.
An hour.
A history.
Quite often you see people writing "an historic achievement", but that's incorrect because the H is voiced in historic.
Where it gets a bit vague is stuff like "SQL statement", because some people would say it like "Sequel statement", others will say it like "Ess-Queue-Ell statement".
eg.
An apple.
A banana.
An hour.
A history.
Quite often you see people writing "an historic achievement", but that's incorrect because the H is voiced in historic.
Where it gets a bit vague is stuff like "SQL statement", because some people would say it like "Sequel statement", others will say it like "Ess-Queue-Ell statement".
> Quite often you see people writing "an historic achievement", but that's incorrect because the H is voiced in historic.
Many accents drop their leading 'H' sounds.
Many accents drop their leading 'H' sounds.
I wish I could care less about such things, but sometimes linguistic descriptivism is the wrong path to take.
The H should be voiced. Just because some people are too lazy to speak their own language correctly doesn't make it correct, in my worthless opinion.
The H should be voiced. Just because some people are too lazy to speak their own language correctly doesn't make it correct, in my worthless opinion.
Interpretation of results:
An individualised, progressive walking and education intervention significantly reduced low back pain recurrence. This accessible, scalable, and safe intervention could affect how low back pain is managed.
An individualised, progressive walking and education intervention significantly reduced low back pain recurrence. This accessible, scalable, and safe intervention could affect how low back pain is managed.
there was a greater number of adverse events related to the lower extremities in the intervention group than in the control group (100 in the intervention group and 54 in the control group)
This kind of confused me. Seems to imply the intervention group experienced a greater number of "adverse events"?
This kind of confused me. Seems to imply the intervention group experienced a greater number of "adverse events"?
same overall probability of adverse events in both groups, but the nature of adverse events reported differed between the two.
I interpreted this to mean that the walking group suffered a greater number of leg and foot problems than did the non-walking group.
Adverse events related to the lower extremities includes any reported event -- like blisters, sore feet, twisted ankles -- and other things that you would expect to see increase in a group of people who were encouraged to walk versus a sedentary group.
I had a disc injury about two years ago, so this is fresh for me. I've always been pretty active and consider myself to be in really good shape, but I started running longer distances leading up to a marathon and bad things happened. I think my hamstrings tightened up, which pulled on other things, and it all came to a head during a golf swing where I could hear an audible crack. Pain was 9/10 and I couldn't stand up straight for a solid month.
After 12 months of trying many things, including 6 months of PT, I believe the following things to be true: - Walking is better than sitting because it gets things moving - Ice as soon as possible if you have a flare-up - Strength core/training is essential. I have always been in good shape from a cardio perspective, but never lifted weights. Now I have 12 weight-lifting exercises that I do 2 sets of 20 at the gym twice per week. Also, I do 40 lunges on a Roman chair at home every day, which my physical therapist told me is the single most important exercise.
It's a lot of work and it takes a lot of time, but I seem to recover faster if I have a flare-up, and they're not as severe. Also, I feel like I'm in better shape overall. It's nice to have some muscle instead of being a noodly-ass dude who can run a long way.
After 12 months of trying many things, including 6 months of PT, I believe the following things to be true: - Walking is better than sitting because it gets things moving - Ice as soon as possible if you have a flare-up - Strength core/training is essential. I have always been in good shape from a cardio perspective, but never lifted weights. Now I have 12 weight-lifting exercises that I do 2 sets of 20 at the gym twice per week. Also, I do 40 lunges on a Roman chair at home every day, which my physical therapist told me is the single most important exercise.
It's a lot of work and it takes a lot of time, but I seem to recover faster if I have a flare-up, and they're not as severe. Also, I feel like I'm in better shape overall. It's nice to have some muscle instead of being a noodly-ass dude who can run a long way.
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I suffered with excruciating lower back problems for years. In the end the "cure" was not commuting (40 minutes each way) to work anymore. The time in the car was the problem.
I still have background low back discomfort -- which I've had since 16 -- but it's nothing like the debilitating agony I was living with.
I still have background low back discomfort -- which I've had since 16 -- but it's nothing like the debilitating agony I was living with.
I don’t know about the lower back specifically, but I know that hiking/ walking long distances is medicine for your knees. And running is medicine for your whole circulatory system and spine. If I don’t exercise, I begin to feel the difference within a couple weeks. But if your knees start to hurt- you need to walk. Standing is no good. It’s walking that helps, and especially walking up and down mountains. Your knees might be sore the first couple times you do this but after a while they will respond to the stimulation and become much tougher.
I don't drive and don't have back pain, I could swear all the people on the net complaining about back pain in their 30s and 40s spend a lot of their time sitting in cars.
Extended periods of sitting are in general is your enemy.
Many people in the US wake up, sit at the kitchen table to eat breakfast (well probably more skip this compared to the past), walk to their car, sit in the car for 20-50 minutes, walk to their office workspace, sit for another 8 hours with few standing/walking breaks, walk to car, sit again for commute home, then sit on the sofa until bedtime.
This is so unhealthy, and it shows in body shape and illnesses.
Many people in the US wake up, sit at the kitchen table to eat breakfast (well probably more skip this compared to the past), walk to their car, sit in the car for 20-50 minutes, walk to their office workspace, sit for another 8 hours with few standing/walking breaks, walk to car, sit again for commute home, then sit on the sofa until bedtime.
This is so unhealthy, and it shows in body shape and illnesses.
So basically, just walk it off
My mom could have had a career as a scientist, apparently.
Any one have any recommendations for a herniated disc. Feels like I have a marble in my spine for 2 years and don’t have health insurance heh
I have two adjacent herniated discs which has basically made me somewhat disabled (I can't sit down at certain angles, lift anything heavier than 15kg without crippling myself). Walking twice a day definitely helps as does these daily exercises:
- Back extensions: https://www.youtube.com/watch?v=Vu0O414sU0c
- Bird dog: https://www.youtube.com/watch?v=QABW99qPiNM
- Hip bridges: https://www.youtube.com/watch?v=mmveFKdpknI
- Light kettle bell swings: https://www.youtube.com/watch?v=cY38L70lxro
- Back extensions: https://www.youtube.com/watch?v=Vu0O414sU0c
- Bird dog: https://www.youtube.com/watch?v=QABW99qPiNM
- Hip bridges: https://www.youtube.com/watch?v=mmveFKdpknI
- Light kettle bell swings: https://www.youtube.com/watch?v=cY38L70lxro
Any thoughts/experience with surgery to excise the herniated portions of the discs?
In addition to whatever credible DIY tips you can find, if you're in the US, you might qualify for Medicaid. https://en.wikipedia.org/wiki/Medicaid
Been investigating that once I have a doctor I’m wondering what therapy to push for or avoid.
One of the tricks to Medicaid is to go to somewhere that your state govt or a hospital has someone set up to do the forms while they ask you questions. Maybe do that very soon, so, when you're trying to make a doctor appointment (which might be scheduled for months away), you can tell them you have insurance.
Back extensions. Both normal and adjusted to target glutes. Slow controlled eccentric movement, pausing a second at maximum stretch between reps.
Hitting the gym in general, but stay away from deadlifts.
Depends which way your spine is bent but for me psoas stretching works well.
I've found anything that puts the spine in tension (hanging by hands or hips) helps with spinal pain. 'leaf pose' from acro yoga's especially great for my partner and I (YMMV)
This might sound crazy, but red light therapy helped my herniated disc a lot. I have a novaalab pad and it seems to have nearly cured my back pain.
Seems reasonable.
I used to deal with lower back pain and don't anymore. What worked for me:
1. Losing weight
2. Walking
3. Lifting weights
Obviously proper form for weightlifting is important, but I had no idea how weak my core was (and how much that impacts back strength) until I put in the effort to improve it.
Being able to bend over without worrying about throwing out my back is such a blessing.
I used to deal with lower back pain and don't anymore. What worked for me:
1. Losing weight
2. Walking
3. Lifting weights
Obviously proper form for weightlifting is important, but I had no idea how weak my core was (and how much that impacts back strength) until I put in the effort to improve it.
Being able to bend over without worrying about throwing out my back is such a blessing.
You're right but word of caution, go easy with advice from things like Stronglifts that claim squats & deadlifts will solve any back problems. They will throw out your back faster than lifting a fridge out of your trunk.
Body weight exercises are much safer and imo better at solving back issues than moving 30Kg of metal around
Body weight exercises are much safer and imo better at solving back issues than moving 30Kg of metal around
I think we need to be more specific that lifting _too_ heavy weights will do this. A properly planned and followed progressive overload program for a beginner should start with form, follow with just the bar, and then add weight slowly while pausing if any unusual stress is encountered.
Bodyweight programs are effective too, of course. Whatever keeps an individual motivated is usually the best choice for them.
Bodyweight programs are effective too, of course. Whatever keeps an individual motivated is usually the best choice for them.
I really agree with this, given that deadlifts are how I got my back problem in the first place. What sort of bodyweight exercises would you recommend?
Plank, side plank, russian twists.
Stretches like bird-dog, cat-cow, bottom to heel stretch, knee to stretch chest, knee rolls, back arch, lunges, bridge, gluteal stretch... (the names are confusion, just look it up and you'll understand). Do them slow, hold the poses, breathe deeply in and especially out.
Do these on a yoga-like mat but thicker (like 1cm, off Amazon). Print some screenshots on to a single piece of paper and you're good to go, at the gym or at home.
Not body weight but real good: full body routines with a kettle bell (Caroline Girvan on YT).
Stretches like bird-dog, cat-cow, bottom to heel stretch, knee to stretch chest, knee rolls, back arch, lunges, bridge, gluteal stretch... (the names are confusion, just look it up and you'll understand). Do them slow, hold the poses, breathe deeply in and especially out.
Do these on a yoga-like mat but thicker (like 1cm, off Amazon). Print some screenshots on to a single piece of paper and you're good to go, at the gym or at home.
Not body weight but real good: full body routines with a kettle bell (Caroline Girvan on YT).
Thank you!
Yeah, it only takes a lapse of concentration to slip into bad form when you're lifting heavy.
I went to a personal trainer in order to learn proper form, and he told me I wasn't ready for barbell lifting yet. It took about 6 months of body weight / mobility training before I was ready.
Even then I only started squats with bar weight, and went slowly with progressive overload. Same with deadlifts, using a trap bar. If I feel tired one session I just skip or cut the set short.
I'm almost 40 so this very cautious approach helped prevent injury. I recommend everyone talk to an experienced personal trainer before they start a weightlifting routine.
I went to a personal trainer in order to learn proper form, and he told me I wasn't ready for barbell lifting yet. It took about 6 months of body weight / mobility training before I was ready.
Even then I only started squats with bar weight, and went slowly with progressive overload. Same with deadlifts, using a trap bar. If I feel tired one session I just skip or cut the set short.
I'm almost 40 so this very cautious approach helped prevent injury. I recommend everyone talk to an experienced personal trainer before they start a weightlifting routine.
Randomized controlled trial, 701 subjects, not blinded. Bottom line:
> The intervention was effective in preventing an episode of activity-limiting low back pain (hazard ratio 0·72 [95% CI 0·60–0·85], p=0·0002). The median days to a recurrence was 208 days (95% CI 149–295) in the intervention group and 112 days (89–140) in the control group. The incremental cost per QALY gained was AU$7802, giving a 94% probability that the intervention was cost-effective at a willingness-to-pay threshold of $28 000. Although the total number of participants experiencing at least one adverse event over 12 months was similar between the intervention and control groups (183 [52%] of 351 and 190 [54%] of 350, respectively, p=0·60), there was a greater number of adverse events related to the lower extremities in the intervention group than in the control group (100 in the intervention group and 54 in the control group).
> The intervention was effective in preventing an episode of activity-limiting low back pain (hazard ratio 0·72 [95% CI 0·60–0·85], p=0·0002). The median days to a recurrence was 208 days (95% CI 149–295) in the intervention group and 112 days (89–140) in the control group. The incremental cost per QALY gained was AU$7802, giving a 94% probability that the intervention was cost-effective at a willingness-to-pay threshold of $28 000. Although the total number of participants experiencing at least one adverse event over 12 months was similar between the intervention and control groups (183 [52%] of 351 and 190 [54%] of 350, respectively, p=0·60), there was a greater number of adverse events related to the lower extremities in the intervention group than in the control group (100 in the intervention group and 54 in the control group).
> not blinded
Not at all practical to blind this intervention. Humans aren't that stupid, they will notice whether they were actually walking or not.
Not at all practical to blind this intervention. Humans aren't that stupid, they will notice whether they were actually walking or not.
AVP them all and have some walk while sitting virtually and vice versa :)
Back pain? Look into Dr Stuart McGill.
Do his "big 3" exercises.
Stop flexing your spine.
Do his "big 3" exercises.
Stop flexing your spine.
A shame they couldn't control for performance bias. Six sessions with a physiotherapist would probably make a difference in outcomes even without the walking.
YMMV but what solved my back pain was lifting weights - specifically squats and legs exercises that activate back muscles. Form is important!
There are numerous sentences that do not make sense… including the tautology in the opening sentence. I am suspecting an LLM wrote this?
Psoas stretching is difficult to get right but works miracle for me
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