Walking for Low Back Pain Prevention

Low back pain is a pervasive and often debilitating condition that affects a significant portion of the global population. Its recurrence poses a substantial health and economic burden, with many individuals experiencing repeated episodes of pain that can lead to prolonged disability and increased healthcare costs. Despite widespread recommendations for exercise as a preventive measure, there has been a need for clear evidence on the effectiveness and cost-effectiveness of accessible, low-cost interventions. The WalkBack study, a groundbreaking randomised controlled trial conducted in Australia, offers valuable insights into how a simple walking and education programme can significantly reduce the recurrence of low back pain.

Study Overview

The WalkBack study aimed to investigate the clinical effectiveness and cost-effectiveness of an individualised, progressive walking and education intervention compared to a no-treatment control group. The trial involved 701 participants who had recently recovered from an episode of non-specific low back pain. Participants were randomly assigned to either a walking and education intervention facilitated by six sessions with a physiotherapist over six months or a no-treatment control group. The primary outcome was the time to the first recurrence of activity-limiting low back pain, with follow-up periods ranging from 12 to 36 months.

The findings were compelling: the intervention group had a significantly lower risk of experiencing a recurrence of low back pain compared to the control group. The median days to recurrence were 208 days in the intervention group versus 112 days in the control group. Moreover, the incremental cost per quality-adjusted life-year (QALY) gained was AU$7802, with a 94% probability of cost-effectiveness at a willingness-to-pay threshold of $28,000.

Practical Applications for Clients

The WalkBack study underscores the importance of incorporating simple, cost-effective interventions into the management of low back pain. For us as fitness professionals, these findings highlight the potential of progressive walking programmes to significantly reduce the recurrence of low back pain in clients. Here are some practical applications based on the study’s results:

• Individualised Walking Plans: Tailor walking programmes to each client’s current fitness level, medical history, and personal goals. The initial walking prescription should be based on a thorough assessment conducted during the first session with the client.
• Gradual Progression: Encourage clients to start with manageable walking durations and gradually increase the intensity and frequency. The goal is to walk five times per week for at least 30 minutes daily by the end of six months.
• Health Coaching Approach: Use health coaching principles to support long-term adherence to the walking programme. This includes active listening, goal setting, and motivational interviewing to help clients overcome barriers and stay committed.
• Monitoring and Feedback: Provide clients with tools such as pedometers and walking diaries to track their progress. Regular follow-up sessions can help adjust the walking programme as needed and address any concerns or challenges.
• Education and Self-Management: Educate clients about modern pain science and strategies to reduce the risk of recurrence. Empower them with knowledge on how to self-manage minor recurrences of low back pain.

Integrating Progressive Walking Programmes

Incorporating a structured walking programme into fitness routines can be an effective way to prevent low back pain recurrence. The WalkBack study provides a robust framework for fitness professionals to develop and implement such programmes. Here are guidelines on how to integrate progressive walking programmes into clients’ exercise plans:

• Assessment and Planning:
  • Initial Assessment: Conduct a comprehensive assessment of the client’s current physical activity levels, medical history, and any existing limitations or concerns related to low back pain.
  • Goal Setting: Collaborate with the client to set realistic and achievable goals for the walking programme. These goals should be specific, measurable, and time-bound.
• Designing the Programme:
  • Starting Point: Determine the appropriate starting point for each client based on their assessment. This could be as simple as a 10-minute walk, gradually increasing to the target of 30 minutes.
  • Progression Plan: Outline a clear progression plan that includes incremental increases in walking duration and intensity. For example, increase the walking time by 5 minutes each week until the client reaches the target duration.
• Implementation:
  • Consistency: Encourage clients to incorporate walking into their daily routines. Consistency is key, so finding a regular time and place for walking can help establish a habit.
  • Variety: Introduce variety to keep the walking programme interesting. This could include different walking routes, varying the pace, or incorporating intervals of brisk walking.
• Support and Motivation:
  • Health Coaching: Utilise health coaching techniques to provide ongoing support and motivation. This can include regular check-ins, setting short-term goals, and celebrating milestones.
  • Social Support: Encourage clients to walk with family members or friends to enhance motivation and enjoyment.
• Monitoring and Adjustments:
  • Tracking Progress: Use pedometers or fitness apps to help clients track their walking sessions. Reviewing this data can provide valuable feedback and help adjust the programme as needed.
  • Addressing Challenges: Be proactive in addressing any challenges or setbacks. This might involve modifying the walking route, adjusting the pace, or providing additional education on managing low back pain.
• Education and Empowerment:
  • Pain Science Education: Educate clients on the basics of pain science, including the importance of movement and the role of walking in managing and preventing low back pain.
  • Self-Management Strategies: Teach clients simple self-management techniques, such as stretching exercises, posture correction, and ergonomic adjustments to their daily activities.

The WalkBack study highlights the significant role that walking can play in preventing the recurrence of low back pain. By integrating progressive walking programmes into clients’ fitness routines, fitness professionals can offer a cost-effective, accessible, and scalable intervention that aligns with current best practices in low back pain management. Through individualised planning, gradual progression, ongoing support, and client education, fitness professionals can help clients achieve long-term success in managing their low back pain and improving their overall quality of life.

References

Pocovi, N. C., Lin, C.-W. C., French, S. D., Graham, P. L., van Dongen, J. M., Latimer, J., Merom, D., Tiedemann, A., Maher, C. G., Clavisi, O., Tong, S. Y. K., & Hancock, M. J. (2024). 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. The Lancet, 404(134-144). Click here to review the full research article

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Low Back Pain Management Course – Distance Study

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Specialise in Strength & Conditioning with a Focus on Low Back Pain Management

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