The Effects of Walking on Low Back Pain

What is Low Back Pain ?[edit | edit source]

Low back pain that is not associated with serious or potentially serious causes has been described in the literature as 'non-specific', 'mechanical', 'musculoskeletal' or 'simple' low back pain.[1] Non-specific low back pain is defined as low back pain not attributable to a recognisable, known specific pathology (eg, infection, tumour, osteoporosis, fracture, structural deformity, inflammatory disorder, radicular syndrome, or cauda equina syndrome).[2]

Lower back pain can be further split into three categories; acute, sub-acute and chronic.[3]

  1. Acute is anything that persists less than 6 weeks.
  2. Sub-acute is anything persisting between 6-12 weeks.
  3. Chronic is anything persisting for 12 weeks or more.


Lower back pain is commonly described to be between the anatomical regions of the ribs and gluteal folds.[4]

[5]Low back pain between rib cage and gluteal folds


The lumbar spine comprises the lower end of the spinal column between the last thoracic vertebra (T12) and the first sacral vertebra (S1). There is a total of five lumbar vertebra (L1-L5) that are much larger compared to other regions within the vertebral column. These large facets help support the upper body ,as they absorb axial forces (against gravity) delivered from the head, neck and trunk, and provide protection for the spinal cord from the canal that is formed. The lumbar spine allows for diverse types of trunk motion, including flexion, extension, rotation, and side bending, thus providing further reasons as to why the facets are much larger. Each lumber facet consists of multiple components; vertebral body, transverse process, super articular process, super articular facet, intervertebral disc, vertebral forearm, pedicle of vertebral arch, lamina of vertebral arch and a spinous process.[6]

Epidemiology[edit | edit source]

Low back pain causes more disability than any other condition, affecting 1 in 10 people and becoming more common with increasing age,[7]with rates of 1%–6% in children aged 7–10 years, 18% in adolescents, and a peak prevalence ranging from 28% to 42% in people between 40 years and 69 years.[8]

One study that was carried out in 195 countries assessing the incidence, prevalence, and years lived with disability for 354 medical conditions found low back pain to be the leading cause of worldwide productivity loss as measured in years, and the top cause of years lived with disability in 126 countries.[8] In the UK it is estimated that low back pain is responsible for 37% of all chronic pain in men and 44% in women and the total cost of low back pain to the UK economy is reckoned to be over £12 billion per year.[7]

Pedometer Driven Walking[edit | edit source]

Pedometers are a device which works by counting the steps someone takes to estimate the distance they have travelled.[9] ADD WHERE PEDOMETERS ARE WORN - CHECK INDIVIDUAL INSTRUSTIONS ON EACH.

TO INSERT PICTURE OF PEDOMETER - TAKE OWN PICTURE

Whilst not a pedometer in the traditional sense, the NHS (National Health Service) also have an app which is free to download called 'Active 10' - this is designed to track walking and will indicate the total amount walked and how much of that was brisk walking. [10] Within the app there are also options to set goals, achieve milestones and view progress over the weeks and months. [10] So a pedometer is not the only option to keep a track of walking and daily activity - there are many more apps out there!

Do Pedometers Increase Activity?[edit | edit source]

Pedometers and Goal Setting[edit | edit source]

Pedometer Effects on Low Back Pain[edit | edit source]

Walking Effects on Low Back Pain[edit | edit source]

The lower back muscles play an important role in maintaining its stability and movement; two key aspects that are needed when walking [11]. These muscles can become deconditioned in those with sedentary lifestyles, leading to weakness over time. This prolonged weakness can increase muscular fatigue, and injury, exaggerating the pain already being experienced [11]. Reduced physical activity can also cause these muscles and the joints of the lumbar spine to become stiff, which can increase the pressure on the lower back [12].

Walking has many positive impacts on the lower back, which can prevent or reduce these changes occurring [13] in the following ways:

  1. Increased blood flow:
    • Small blood vessels and capillaries in the lower back muscles can become constricted following decreased physical activity, reducing the blood flow to these muscles [14].
    • Walking allows for more movement in these muscles, allowing these capillaries and blood vessels to open up again.
    • This, in turn, increases the blood supply and nutrients to these muscles, improving muscular health and strength and aiding with the healing process [12].
  2. Stretch and contraction of muscles:
    • The movement in the lower back during walking increases the stretch and contraction of the lower back muscles and those in the legs, buttocks, and core, allowing for more flexibility and mobility in this area .
    • This flexibility increases the overall range of motion in the lower back, also improving the health and strength of the lower back muscles [14].


Current evidence supports the use of walking as a treatment option for low back pain. A cross-sectional study from 2017 evaluating the relationship between walking and low back pain, consisting of 5,982 adults, found that walking was associated with a reduced risk of low back pain [15]. The authors also found that the presence of low back pain was proportionate to walking frequency, with those who walked more often having reduced low back pain. These results are supported by those of a systematic review from 2019 evaluating the effects of walking on those with chronic low back pain [16]. Walking was found to be as effective as other non-pharmacological interventions on pain and disability in short-term (<3 months) and intermediate (3-12 months) follow-ups. These findings allowed for walking to be recommended for managing and treating low back pain [16].

The effects of walking have been compared to the effects of exercise for low back pain. A systematic review from 2019 comparing the two concluded that walking was as effective as exercise for improving pain, disability, quality of life, and fear-avoidance in those with chronic low back pain [17]. Much like the studies by Kim, et al (2019)[15] and Sitthipornvorakul, et al (2018)[16], Vanti, et al (2019)[17] recommend the use of walking as a treatment and management option for low back pain.

Interestingly, a systematic review from 2022, found that people with low back pain have altered gait patterns compared with healthy individuals [18]. Those with low back pain were found to walk slower, have reduced stride lengths, greater lumbar paraspinal activation, and reduced thorax/pelvic coordination [18]. However, the authors were unable to report if these changes were adaptive or maladaptive. Overall, these results indicate that gait re-education may be needed for those with low back pain to gain the most benefits from walking.

Treatment and Management[edit | edit source]

The Department of Health and Social Care recommend that adults take part in at least 150 minutes of "moderate level" activity weekly (reference).

  • Examples of "moderate level" activity is anything that increases the heart rate and breathing rate, such as brisk walking, cycling or mowing the lawn.

Walking is a good low-impact exercise for patients with lower back pain to begin increasing their levels of physical activity.

"Walking is a very cost-effective treatment method that can be carried out anywhere at any time. It is recommended to exercise for at least 15 to 30 minutes most days for those with low back pain (Nall & Morrison, 2019). So, this can mean gradually building up walking distance and capacity to reduce the risk of injury and allow for the body to adapt to the changes. Having the correct walking posture is important to allow for more comfortable walking, helping to reduce pain and discomfort [19]. An optimal posture can be achieved using multiple strategies:

  1. Stand up straight:
    • This can be achieved by making yourself as tall as possible, without leaning forwards or backwards.
    • Ensuring your chin is kept up and your eyes facing forwards allows for reduced strain on your neck and back [19].
    • These together will allow for a better posture and improved balance [20].
  2. Keep shoulders back and relaxed:
    • Relaxing your shoulders helps relieve tension and allows for a more neutral spine when walking [19].
  3. Engage core muscles and keep a neutral pelvis:
    • engaging your core and keeping a neutral pelvis prevents arching of the spine and tilting of the pelvis, allowing for a more neutral spine and better posture [21]."

Management strategies[edit | edit source]

The use of a pedometer means that the patient is able to manage and keep track of their steps whilst walking. The patient might be advised to keep an "activity diary", as shown below, which keeps track of a daily step count and the patients' step goal.

Insert example of activity diary

The use of an activity diary can also help establish the patients' baseline in the first week, which is important in informing their individual goals for rehabilitation (reference). This is achieved by calculating the patient's average step count in the first week of activity, and using this as a baseline when deciding a step goal for the second week.

Outcome measures[edit | edit source]

Goal setting[edit | edit source]

Suggestions for Future Clinical Research[edit | edit source]

References[edit | edit source]

  1. ↑ NICE Guidelines (2016). Context | Low back pain and sciatica in over 16s: assessment and management | Guidance | NICE. [online] Nice.org.uk. Available at: https://www.nice.org.uk/guidance/NG59/chapter/Context [Accessed 12 May 2022].
  2. ↑ Balagué, F., Mannion, A.F., Pellisé, F. and Cedraschi, C. (2012). Non-specific low back pain. The Lancet, 379(9814), pp.482–491. doi:10.1016/s0140-6736(11)60610-7.
  3. ↑ Burton, A.K., Balagué, F., Cardon, G., Eriksen, H.R., Henrotin, Y., Lahad, A., Leclerc, A., Müller, G. and van der Beek, A.J. (2006). Chapter 2 European guidelines for prevention in low back pain. European Spine Journal, 15(S2), pp.s136–s168. doi:10.1007/s00586-006-1070-3.
  4. ↑ Dixit, R. (2017). Chapter 47 - Low Back Pain. [online] ScienceDirect. Available at: https://www.sciencedirect.com/science/article/pii/B9780323316965000474 [Accessed 12 May 2022].
  5. ↑ Heywood, C. (2015). Will my low back pain get better? | Physiotherapy | Team Rehab uk. [online] Physiotherapy | Back Pain | Sports Injury | Rehabilitation | Corby & Moulton, Northants. Available at: https://www.teamrehab.uk/lower_back_pain_northampton_corby_moulton.html [Accessed 13 May 2022].
  6. ↑ Sassack, B. and Carrier, J.D. (2020). Anatomy, Back, Lumbar Spine. [online] PubMed. Available at: https://www.ncbi.nlm.nih.gov/books/NBK557616/.
  7. ↑ 7.0 7.1 https://www.facebook.com/NationalInstituteforHealthandCareExcellence (2016). NICE publishes updated advice on treating low back pain | News and features | News | NICE. [online] NICE. Available at: https://www.nice.org.uk/news/article/nice-publishes-updated-advice-on-treating-low-back-pain.
  8. ↑ 8.0 8.1 Knezevic, N.N., Candido, K.D., Vlaeyen, J.W.S., Van Zundert, J. and Cohen, S.P. (2021). Low back pain. The Lancet, 398(10294). doi:10.1016/s0140-6736(21)00733-9.
  9. ↑ OED Online. Pedometer, n. [online] Available from: https://www.oed.com/view/Entry/139645?rskey=SBOh5n&result=2&isAdvanced=false#eid (accessed 15th May 2022)
  10. ↑ 10.0 10.1 NHS. Get active - Better Health [online]. nhs.uk. 2020. Available from: https://www.nhs.uk/better-health/get-active/ (Accessed 15th May 2022) ‌
  11. ↑ 11.0 11.1 Valdivieso, P., Franchi, M. V., Gerber, C. & Flück, M., 2018. Does a Better Perfusion of Deconditioned Muscle Tissue Release Chronic Low Back Pain?. Frontiers in Medicine, 5(1), p. 77.
  12. ↑ 12.0 12.1 Gordon, R. & Bloxham, S., 2016. A Systematic Review of the Effects of Exercise and Physical Activity on Non-Specific Chronic Low Back Pain. Healthcare, 4(2), p. 22.
  13. ↑ Bumgardner, W. & Tanaka, M. J., 2021. Walking Away Your Low Back Pain. [Online] Available at: https://www.verywellfit.com/walking-away-low-back-pain-3435479#toc-does-walking-really-prevent-low-back-pain [Accessed 15 05 2022].
  14. ↑ 14.0 14.1 Cole, A., 2019. 2 Reasons Why Walking Is Good for Your Lower Back. [Online] Available at: https://www.spine-health.com/blog/2-reasons-why-walking-good-your-lower-back#vh_footnotes [Accessed 15 05 2022].
  15. ↑ 15.0 15.1 Kim, H. et al., 2017. Association Between Walking and Low Back Pain in the Korean Population: A Cross-Sectional Study. Annals of Rehabilitation Medicine, 41(5), pp. 786-792.
  16. ↑ 16.0 16.1 16.2 Sitthipornvorakul, E., Klinsophon, T., Sihawong, R. & Janwantanakul, P., 2018. The effects of walking intervention in patients with chronic low back pain: A meta-analysis of randomized controlled trials. Musculoskeletal Science & Practice, 34(1), pp. 38-46.
  17. ↑ 17.0 17.1 Vanti, C. et al., 2019. The effectiveness of walking versus exercise on pain and function in chronic low back pain: a systematic review and meta-analysis of randomized trials. Disability and Rehabilitation, 41(6), pp. 622-632.
  18. ↑ 18.0 18.1 Smith, J. A. et al., 2022. Do people with low back pain walk differently? A systematic review and meta-analysis. Journal of Sport and Health Science.
  19. ↑ 19.0 19.1 19.2 Bumgardner, W. & Lau, M., 2021. How to Improve Your Walking Posture. [Online] Available at: https://www.verywellfit.com/how-to-walk-walking-posture-3432476 [Accessed 16 05 2022].
  20. ↑ Pickle, N. T., Grabowski, A. M., Auyang, A. G. & Silverman, A. K., 2016. The functional roles of muscles during sloped walking. Journal of Biomechanics, 49(14), pp. 3244-3251.
  21. ↑ Jung, J., Yu, J. & Kang, H., 2012. Differences in Trunk Muscle Activities and Ratios between Unstable Supine and Prone Bridging Exercises in Individuals with Low Back Pain. Journal of Physical Therapy Science, 24(9), pp. 889-892.
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