Prescriber cites an interesting study on the use of a walking programme for back pain: Pain 2015; 156(1): 131 – 47. In this RCT, the use of a walking programme, usual tailored physical therapy, and a weekly group exercise class, were compared for chronic back pain, and the walking programme worked just as well. Actually, when you look beyond average change in pain and function to the number of walkers in each group who showed clinically significant changes on the score, the walkers scored higher. They were also more likely to adhere to the programme (which I’m guessing could have been the reason for the equal success rate – maybe it’s actually less effective when done but more likely to be done?) Time off work was similar in each group. The walking programme, not surprisingly, was the most cost effective.
Here’s how it worked: The patients were given a pedometer, a walking diary, a booklet that explains back pain (given to all patients), and instructions to walk at least four days a week for ten minutes at a time, and to gradually increase the walk’s duration and intensity with the aim of working up to a 30-minute brisk walk or other moderate physical activity five days a week. They were then given weekly phone calls to support them. The intervention lasted up to eight weeks.
The treatment group had all had back pain either for at least three months, or on at least three occasions in the past year. They also had low levels of physical activity, so it may well be that this wouldn’t be helpful in patients who were already active.
How effectively I could implement that in practice, I don’t know. Must be possible to get a booklet on back pain; there are the patient.co.uk leaflets, and probably our practice has some within the basketfuls. I don’t have oodles of pedometers and walking diaries to hand out, or the time to make weekly pep talk phone calls, but I wonder if it would help just to give out the advice to try the walking programme for themselves, backed up with encouragement and the information that it had been shown to be useful in patients who followed it? Certainly worth a try.