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!,” Beedie et al, British Journal of Sports Medicine, 2016.
- “Neck muscle training in the treatment of chronic neck pain: a three-year follow-up study,” Ylinen et al, Europa Medicophysica, 2007.
- “Backward Walking: A Possible Active Exercise for Low Back Pain Reduction and Enhanced Function in Athletes,” Janet et al, Journal of Exercise Physiologyonline, 2011.
- “An update of stabilisation exercises for low back pain: a systematic review with meta-analysis,” Smith et al, 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,” Ferreira et al, 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:
- Classical Conditioning Fails to Elicit Allodynia in an Experimental Study with Healthy Humans. Madden 2017 Pain Med.
- Topical glyceryl trinitrate (GTN) and eccentric exercises in the treatment of mid-portion achilles tendinopathy (the NEAT trial): a randomised double-blind placebo-controlled trial. Kirwan 2024 Br J Sports Med.
- Placebo analgesia in physical and psychological interventions: Systematic review and meta-analysis of three-armed trials. Hohenschurz-Schmidt 2024 Eur J Pain.
- Recovery trajectories in common musculoskeletal complaints by diagnosis contra prognostic phenotypes. Aasdahl 2021 BMC Musculoskelet Disord.
- Cannabidiol (CBD) products for pain: ineffective, expensive, and with potential harms. Moore 2023 J Pain.