Improve Low Back Pain with Walking and Mind-Body Practices
By John M. de Castro, Ph.D.
“Mindfulness training teaches us to be aware of, and accept, moment-to-moment physical sensations of discomfort, while letting go of our usual negative reactions. So instead of spending hours each day thinking about how much we hate our back pain, worrying about our prognosis, and seeking relief, we learn how to be with the pain — paying attention to how it actually feels at each moment and relaxing our tendency to tense up against it, while observing our worried or distressed thoughts and feelings coming and going.” – Ronald Siegel
Low Back Pain is the leading cause of disability worldwide and affects between 6% to 15% of the population. It is estimated, however, that 80% of the population will experience back pain sometime during their lives. There are varied treatments for low back pain including chiropractic care, acupuncture, biofeedback, physical therapy, cognitive behavioral therapy, massage, surgery, opiate pain killing drugs, steroid injections, and muscle relaxant drugs. These therapies are sometimes effective particularly for acute back pain. But, for chronic conditions the treatments are less effective and often require continuing treatment for years and opiate pain killers are dangerous and can lead to abuse, addiction, and fatal overdoses.
Obviously, there is a need for safe and effective treatments for low back pain that are low cost and don’t have troublesome side effects. Mindfulness practices are effective in treating pain and have been shown to be safe and effective in the management of low back pain. Yoga practice has been shown to have a myriad of health benefits. These include relief of chronic pain. Yoga practice has also been shown to be effective for the relief of chronic low-back pain. Other mind-body practices such as Tai Chi improves spinal health and reduces pain. The evidence is accumulating, so, it would seem reasonable to summarize what has been learned regarding the ability of mind-body practices to treat chronic low back pain.
In today’s Research News article “Effectiveness of walking versus mind-body therapies in chronic low back pain: A systematic review and meta-analysis of recent randomized controlled trials.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7458239/ ) Nduwimana and colleagues reviewed, summarized, and performed a meta-analysis of the published randomized controlled trials comparing the effectiveness of m1nd-body practices and walking for the relief of chronic low back pain. They identified 31 published trials containing a total of 3193 participants.
They report that the published research found that both walking and m1nd-body practices were effective in significantly reducing low back pain. Of the m1nd-body practices, yoga was particularly effective not only reducing pain but also producing significant reductions in activity limitations resulting from low back pain. On the short-term (up to 3 months) yoga produced significant pain reductions while on the intermediate-term (3 to 6 months), walking produced significant pain reductions.
These results are important as low back pain is ubiquitous and produces not only discomfort but also limitations on the ability of patients to conduct their lives. So, its relief greatly reduces the suffering and improves the quality of life. The comparison of mind-body practices to walking is important as both are exercises and their relative effectiveness assessed. The results suggest that yoga practice has better short-term effectiveness while walking appears to be better for the intermediate term. This further suggests that future research should explore the effectiveness of the combination of mind-body practices and walking in the treatment of low back pain.
So, improve low back pain with walking and mind-body practices.
“Mindbody treatments (designed to change these attitudes, feeling, and beliefs about pain) can measurably reduce back pain over time.” – Curable
CMCS – Center for Mindfulness and Contemplative Studies
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Nduwimana, I., Nindorera, F., Thonnard, J. L., & Kossi, O. (2020). Effectiveness of walking versus mind-body therapies in chronic low back pain: A systematic review and meta-analysis of recent randomized controlled trials. Medicine, 99(35), e21969. https://doi.org/10.1097/MD.0000000000021969
Walking and mind-body therapies (MBTs) are commonly recommended to relieve pain and improve function in patients with chronic low back pain (CLBP). The purpose of this study was to compare the effectiveness of walking and MBTs in CLBP.
We included randomized controlled trials (RCTs) comparing walking or MBTs to any other intervention or control in adults with CLBP. Studies were identified through PubMed, Cochrane Library, PsycINFO, Scopus, and ScienceDirect databases. The research was limited to studies published in English and French between January 2008 and December 2018. Two reviewers independently selected the studies, extracted data, and assessed studies quality using the Physiotherapy Evidence Database (PEDro) scale. Statistical analyses were performed under a random-effects model. We analyzed pain and activity limitation, with the calculation of standardized mean differences and 95% confidence intervals for the different treatment effects.
Thirty one randomized controlled trials involving 3193 participants were analyzed. Walking was as effective as control interventions in the short-term and slightly superior in the intermediate term with respect to pain (Standardized mean differences (SMD) = –0.34; 95% CI, –0.65 to –0.03; P = .03) and activity limitation (SMD = –0.30; 95% CI, –0.50 to –0.10; P = .003). In contrast, yoga was more effective than control interventions in the short term in terms of pain (SMD = –1.47; 95% CI, –2.26 to –0.68; P = .0003) and activity limitation (SMD = –1.17; 95% CI, –1.80 to –0.55; P = .0002). Yoga was no longer superior to the control interventions for pain at the 6-month follow-up.
MBTs, especially yoga, seem to be more effective in the short term, and walking seems to be more effective in the intermediate term, for the relief of pain and activity limitation in patients with CLBP. A combination of walking and MBTs fits the biopsychosocial model and might be valuable therapy for CLBP throughout follow-up due to combined effects.