Walking three times a week ‘nearly halves’ recurrence of low back pain

Walking three times a week to ease back pain almost halves the risk of its recurrence, according to the first study of its kind.

About 800 million people worldwide have low back pain, and seven in 10 who recover experience flare-ups within a year.

Researchers said the findings, published in the Lancet, show walking could have a “profound impact” on the leading cause of disability worldwide.

“You don’t need to be walking 5 or 10km every day to get these benefits,” said Mark Hancock, the study’s senior author and a professor of physiotherapy at Macquarie University in Australia.

“The important thing to remember is to start with short walks then gradually increase the distance and intensity as your fitness increases. Walking is a low-cost, widely accessible and simple exercise that almost anyone can engage in, regardless of geographic location, age or socioeconomic status.”

Hancock said people who walked three to five times a week, for an average of 130 minutes a week, remained pain-free for nearly twice as long compared with those who did not receive any treatment.

Taking regular steps also improved their quality of life, and the time they had to take off work almost halved, he added.

In the world’s first randomised controlled trial assessing the effectiveness of walking to prevent low back pain recurrence, scientists followed 701 adults for three years who had recently had an episode of low back pain.

Half were assigned to a walking scheme and education sessions from a physiotherapist, while the rest were assigned to a control group and not provided with any specific intervention.

“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,” said Hancock. “The risk of having a recurrence that required seeking care was nearly halved in those in the intervention group.

“We gave them a rough guide of building up to 30 minutes, five times a week, over a six-month period. After three months, most of the people who took part were walking three to five days a week for an average total of 130 minutes.”

He added: “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.”

Rory Fagan joined the trial in 2021, seeking relief from a back injury sustained playing rugby in his 20s. In the three years since he has been walking three times a week, he has had just one episode of debilitating pain.

“The thing with back pain is most people’s instinct is to not do anything, because even taking a step can send a jolt or spasm up your back,” he said. “Exercise is a path to reducing pain in the long term, so if you have a flare-up, you should keep doing what you can.”

Prof Kamila Hawthorne, the chair of the Royal College of GPs in the UK, welcomed the research and said it was “important” the results were “taken onboard as clinical guidance is developed and updated”.

Dr Athalie Redwood-Brown, a senior lecturer in physical activity and health at Nottingham Trent University, said the findings had “the potential to transform preventive care, offering a scalable solution that could benefit millions”.