Walking can help most back pain issues

When you have back pain, it’s hard to get motivated to walk. But, in most cases, walking is exactly what you should do, according to a new study published in the journal The Lancet.  The study included 701 participants who were relatively sedentary and who had recently recovered from an episode of lower back pain.

The participants were divided into two groups. The first group received an individualized walking and education program of six sessions over six months. The goal for that group was to walk five times a week for at least 30 minutes daily. The second group wasn’t assigned to walk. Those who walked regularly went nearly twice as long without their back pain returning (208 days versus 112 days).

“Walking is great for everything,” said neurological surgeon Achilles Papavasiliou, MD. “It is a great low impact exercise that has been shown to be good for your heart and brain health. And now it has been shown to decrease the incidence of back pain. My wife and I try to walk every day for a half hour. If you can’t do 30 minutes at once, 15 minutes twice a day or 10 minutes three times a day is just as good.” 

Two Common Causes of Back Pain

There are a variety of reasons patients develop low back pain. Two of the most common reasons are due to a herniated disc or spinal stenosis, said Dr. Papavasiliou, who practices at Cape Cod Healthcare Neurosurgery in Hyannis, MA.

“Patients with a disc herniation tend to be younger and have acute onset lower back and leg pain. Spinal stenosis tends to develop slowly as we age and is due to narrowing of the spine,” he said. “In general, I think walking is great for both of these types of patients.”

Disc Herniation

The disc is the shock absorber of the spine. As we age, our discs degenerate leading to fissures in the disc space and a possible disc herniation, according to Dr. Papavasiliou. When the disc herniates, it can put pressure on a nerve and lead to back and leg pain. The natural history of most disc herniations is for slow improvement over a period of 6 to 12 weeks, as the body reabsorbs the disc herniation and pressure comes off the nerve root, he said.

“Patients with a herniated disc typically have more trouble sitting. This is because sitting loads the disc space the most, so when patients sit, the intradiscal pressure is higher, leading to more pain,” he said.

Researchers have done studies where they put a needle into the disc space and measure the intradiscal pressure while participants are sitting, standing and walking, and the disc pressure is highest when they were sitting, Dr. Papavasiliou said. It is not surprising many patients with herniated discs feel better and have less discomfort when they are walking, unless the disc herniation is very large.

“For patients with disc herniations, we will often prescribe physical therapy and a possible epidural cortisone injection to help control the pain until the disc is reabsorbed,” he said. “For those patients who present with severe pain and weakness, or for those who do not improve with conservative measures, a minimally invasive microdiscectomy is a good option to alleviate the pain.

Spinal Stenosis

Spinal stenosis or narrowing of the spinal canal is very common as people get older, according to Dr. Papavasiliou. This narrowing occurs as a result of the disc bulging, and the ligaments and joints thickening as we age.

“When spinal stenosis becomes severe enough, patients typically have a hard time walking and have to sit down,” he said. “It is thought the narrowing of the spine decreases the blood flow to the nerves causing pain, numbness and fatigue with walking.”

Prior to developing symptoms due to spinal stenosis, walking and being active over the long term can help prevent back pain.

“Patients who are very active and consistently walk everyday can tolerate really severe stenosis before they develop symptoms because they have a good blood supply to those nerves,” he said. “So, even if you have spinal stenosis, if you’re an avid walker, you tend to be less symptomatic until the stenosis gets really severe.

“When a patient with symptomatic spinal stenosis (i.e. pain with standing and walking that is relieved with sitting) sees us for the first time, we typically refer them for physical therapy and or an epidural cortisone injection. Those patients with mild to moderate stenosis will often improve and not need surgical intervention.”

The good news is that several studies have shown that surgery is very good option for stenosis patients who fail conservative treatment, he said. The surgical treatment for spinal stenosis involves removal of the roof of the spinal canal and is called a laminectomy. This can often be done minimally invasively as an outpatient procedure.

“It is a very good surgery to increase a patient’s ability to walk again without pain. Patients who have stenosis with a spondylolisthesis (misalignment of the spine) or foraminal stenosis (narrowing where the nerve exits the spine) may need a laminectomy and instrumented fusion,” Dr. Papavasiliou said.

Diagnosing a Cause

To diagnose the cause of back pain, an MRI is appropriate for those patients with severe nerve root pain, spinal stenosis symptoms that prevent patients from walking or for an older person who develops severe pain due to a compression fracture, he said. Patients with a pain in their back but no weakness, numbness or leg pain don’t necessarily need imaging to diagnose the problem. Most of them will benefit from physical therapy to strengthen their core and then starting a walking routine, he added.