Walking and strength training for chronic back pain: no difference
PainSci commentary on Shnayderman 2013: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.
Some evidence suggests that the type of exercise you do for back pain is less important than just getting enough of any kind of exercise (Ferreira 2010). So, what works better for chronic low back pain: increasing back strength? Or just a good brisk daily walk?
Researchers compared these approaches in 52 typical patients (all without much exercise in their lives to begin with). Half of them walked on treadmill twice a week for six weeks, while the other half did “active movements and strengthening exercises for the trunk and upper and lower limbs” — the kind of supposedly good-for-your-back strength training the average person fully expects to be prescribed.
The results of each approach were indistinguishable: they all “improved with similar achievements in all outcome measures.”
The inevitable objection to this study is that twice per week for six weeks is just not enough for a difference to emerge, and the researchers know this, but because their experiment “was conducted in the physical therapy department of a public health organization, it has to be feasible and applicable in the future for the therapist and patients” — and that’s a reasonable limitation. More demanding exercise prescriptions are usually a prescription for failure for most sedentary people (the efficacy versus effectiveness problem, see Beedie 2016).
It is possible that a more intense and long term effort — say, 4 days/week for 6 months — would be a completely different story, and we see signs of that from other research (Ylinen 2007 found that persistence paid doing strength training for neck pain). It’s also possible it would not be a different story (according to Smith et al there is “strong evidence stabilisation exercises are not more effective than any other form of active exercise in the long term”).
related content
- “Death by effectiveness: exercise as medicine caught in the efficacy trap!,” Chris Beedie, Steven Mann, Alfonso Jimenez, Lynne Kennedy, Andrew M Lane, Sarah Domone, Stephen Wilson, and Greg Whyte, British Journal of Sports Medicine, 2016.
- “Neck muscle training in the treatment of chronic neck pain: a three-year follow-up study,” J Ylinen, A Häkkinen, M Nykänen, H Kautiainen, and E-P Takala, Europa Medicophysica, 2007.
- “Backward Walking: A Possible Active Exercise for Low Back Pain Reduction and Enhanced Function in Athletes,” Janet, Dufek, Anthony, House, Brent, Mangus, Geoffrey, Melcher, and John Mercer, Journal of Exercise Physiologyonline, 2011.
- “An update of stabilisation exercises for low back pain: a systematic review with meta-analysis,” Benjamin E Smith, Chris Littlewood, and Stephen May, BMC Musculoskeletal Disorders, 2014.
- “Can We Explain Heterogeneity Among Randomized Clinical Trials of Exercise for Chronic Back Pain? A Meta-Regression Analysis of Randomized Controlled Trials,” Manuela L Ferreira, Rob J E M Smeets, Steven J Kamper, Paulo H Ferreira, and Luciana A C Machado, Physical Therapy, 2010.
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- No long-term effects after a three-week open-label placebo treatment for chronic low back pain: a three-year follow-up of a randomized controlled trial. Kleine-Borgmann 2022 Pain.
- Exercise and education versus saline injections for knee osteoarthritis: a randomised controlled equivalence trial. Bandak 2022 Ann Rheum Dis.
- Association of Lumbar MRI Findings with Current and Future Back Pain in a Population-based Cohort Study. Kasch 2022 Spine (Phila Pa 1976).
- A double-blinded randomised controlled study of the value of sequential intravenous and oral magnesium therapy in patients with chronic low back pain with a neuropathic component. Yousef 2013 Anaesthesia.
- Is Neck Posture Subgroup in Late Adolescence a Risk Factor for Persistent Neck Pain in Young Adults? A Prospective Study. Richards 2021 Phys Ther.