What is the best way to treat low back pain?
In short, there is no one-size-fits-all or 'best' approach. But there are many effective ways to treat low back pain.
Over 90% of low back pain resolves on its own without any treatment within 6 weeks. This also causes some misconceptions about which treatments "work." If you received a massage, see a chiropractor, start foam rolling, experiment with essential oils, or change your diet, you may be tempted to attribute those actions to the "cured" low back pain.
This is where research trials take center stage. They are able to tease out true treatment effects.
According to current research, there are several strategies to use when low back pain does not resolve. Furthermore, treatment in the early stages increases the odds of pain resolution, bumping the 90% number.
Exercise falls in the category 'supported treatment' for low back pain. The tricky part is defining which type of exercise to use.
If you walk into a physical therapy clinic, you will see a variety of exercise types - bands, free weights, bodyweight, and machines. The dosage of exercise - meaning the frequency and duration - varies greatly. The exercise details depend on the patient's history, the severity of low back pain, comorbidities, treatment goals, and training history to name a few.
There is no best type of exercise for low back pain. But are certain types of exercise ineffective?
For much of my career, I believed walking fell into the category of minimal effectiveness. Walking is low intensity. It doesn't build muscle or significantly build cardiorespiratory capacity. Surely it must have limited value, right?
New research shows I was wrong.
According to recent research, walking is just as effective as other forms of exercise for treating low back pain. The review pooled five studies and found similar results were for pain and disability when comparing walking to weight training and aerobic exercise.
The researchers wanted to determine how walking and other forms of exercise influence pain, disability, quality of life, and fear-avoidance beliefs and behaviors in individuals with chronic low back pain. In this case, chronic refers to low back pain lasting longer than three months.
Three of the studies analyzed the effect of walking versus exercise, while two evaluated the effect of the combined walking and exercise versus exercise alone.
The results of this review show that walking is not inferior, but equally effective as intensive exercise across the board. It doesn’t matter if you define success as reducing pain and disability or improving quality of life, both walking and exercise help. Furthermore, similar results were achieved at short-, mid-, and long-term follow-up (greater than 6 months).
Walking can improve both metabolic parameters and psychological status, making it a strong option for chronic low back pain. Walking programs are associated with similar patient satisfaction as exercise and demonstrate high adherence.
Do these results mean walking can replace all other forms of exercise? No, they do not.
It is important to remember pain and disability are complex. Research does not support that we need to be strong and powerful to be pain-free. All exercise/activity should have a goal and be specific to the patient, but all exercise does not need to be high-intensity. If the goal is strengthening then high-intensity is needed, but strengthening is not always the goal or necessary for treating low back pain.