According to an article published in the magazine Family Medicine – SEMERGENit is estimated that between 60% and 80% of people will have at least one episode of low back pain in their life, a lumbar pain that affects between 15% and 20% of the population annually (and reaches peaks of 50% in people with working activity). The data, although they may seem so, are not at all exaggerated. Low back pain, According to a studywas the main cause of years lived with disability worldwide in 2020; and a common problem is the recurrence of these pains, since More than two thirds of people affected by them relapse within one year of recovery.
How to avoid this recurrence has been the subject of research for years. One thing seems clear: contrary to popular belief, rest is not a solution. “Today we know that rest not only does not improve lower back pain, but actually makes it worse,” says Sara Laxe, a rehabilitation physician and director of the Scientific Committee of the Spanish Society of Rehabilitation and Physical Medicine (SERMEF). In this regard, a recent study published in The Lancet A study of adults with a history of low back pain has found that a regular walking routine can be very effective in preventing the recurrence of back pain. In fact, people who followed this routine after an episode of low back pain took longer to relapse into another episode (208 days) than those who did not walk (112 days).
“Our intervention reduced the risk of recurrence of low back pain that limited daily activity by 28%, while the recurrence of low back pain that led participants to seek care from a health professional decreased by 43% compared to the control group,” he explains to EL PAÍS Simon FrenchProfessor in the Department of Chiropractic at Macquarie University (Sydney, Australia).
The study’s co-author notes that to date, only a small number of studies have examined the relationship between exercise and low back pain recurrence, but notes that these investigations have focused primarily on complex, group-based exercises that focus on a combination of strengthening and improving spinal endurance and flexibility. “This makes them less feasible for patients, and for exercise to be effective in long-term prevention, we believe that people need to exercise consistently. We consider walking to be a simple, low-cost and largely accessible alternative,” he adds.
For Arturo Such, member of the Spanish Society of Physiotherapy and Pain (SEFID), the results of the study are “in line” with current evidence, which shows a positive relationship between physical activity and health status. Although according to the expert, in general terms, there does not seem to be a great difference in terms of the type of exercises and their effects on pain, “taking into account that the motivational component is important, walking is an interesting activity for those patients who already like to walk. It is cheap, simple and can become a social activity if you walk in a group.”
Walking is fine, but it is not enough
According to Simon French, the benefits of walking to prevent the recurrence of low back pain could be derived “from the gentle movements, the loading and strengthening of the structures and muscles of the spine, and the relaxation and stress relief provided by the release of endorphins derived from physical exercise.” The author of the study, in any case, highlights the importance of designing personalized walking programs that are “realistic, achievable and enjoyable” for each patient. In the research, in fact, the personalized walking routine was accompanied by an educational intervention offered by a physiotherapist that aimed to give people a better understanding of pain and reduce the fear associated with exercise and movement. “It is difficult to determine which of these elements contributed most to preventing low back pain, but it is probably a combination of all of them,” suggests French, who acknowledges that, although walking may be the “most accessible” treatment for the prevention of low back pain, “it is true that it is not a cure.”
“Walking does not greatly influence all metabolic pathways or muscle fibres. It is a fantastic activity, yes, but it can be complemented with a resistance exercise programme,” adds Such. “Obviously, walking is not the magic potion,” agrees Sara Laxe. For the Research and Innovation Coordinator at the Clinical Institute of Medical and Surgical Specialties (ICEMEQ) of the Hospital Clínic de Barcelona, there is no magic potion other than “doing physical exercise three to four times a week” integrating strength, resistance and aerobic training, and working at least all the large muscle groups (deltoids, biceps, abdomen, back erectors, glutes and quadriceps) to have good musculature. “Unfortunately, in the world we live in, most of the patients to whom I make these recommendations do not have time and some also have economic difficulties that increase stress and worsen pain,” laments Laxe, who does not want to place all the responsibility for the pain on the patients, since many times they “have little capacity to manage the causes that have led to that pain.”
The importance of strength and endurance exercises to complement walking, according to the SERMEF spokesperson, is justified by the fact that there is increasing evidence that in some people who suffer from back pain, this pain is due to weakness of the erector muscles of the back. “It is true that there are some patients who have back pain when they walk. This is very common in patients who have spinal stenosis, which is a pathology that occurs more frequently in older people and which means that the space where the spinal cord and the final part of the spinal cord go narrows. However, patients with weakness in the extensor muscles of the back, buttocks, and abdomen, which leads to poor joint biomechanics, also tend to complain of back pain,” says Laxe, who explains that when walking, if the abdomen and buttocks “do not firm” the spine, the muscles of the lumbar region and the erectors of the back “are forced to work harder and, if they are not well trained, they will suffer more and cause more pain.”
For the expert, since the factors that influence pain can be of a very diverse nature, the approach to pain must take into account this diversity. Also, according to Arturo Such, the peculiarities of each patient. “Some patients with pain need more recreational activities, while others need specific exercises, so it seems more important to recognize the patients who can benefit from one treatment or another. For this reason, professional advice regarding activity and self-management guidelines for possible future episodes is important,” he concludes.
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