Could Walking Be the Key to Easing Your Lower Back Pain?

If you’re experiencing lower back pain, your first instinct might be to take it easy and stay on the couch binging Netflix. And who could blame you? After all, no one wants to do anything that would make their discomfort any worse.

But instead of putting your feet up, you might want to slip them into a pair of walking shoes and start strolling to help ease your aching back.

The WalkBack trial, a June 2024 study published in The Lancet¹ involving more than 3,000 people who had recently recovered from back pain, found that those who participated in a structured walking program—including educational sessions with a physical therapist—substantially reduced their risk of back pain recurrence compared to a control group that didn’t participate in the walking program.

The potential of walking to help chronic lower back pain is significant. Chronic lower back pain is a public health crisis affecting up to 40 percent of Americans, including one out of every three adults ages 18 to 29, according to the Centers for Disease Control and Prevention (CDC).

Severe, chronic back pain is the leading cause of job-related disability and a top contributor to lost work days and health care visits, according to the U.S. 2019 National Health Interview Survey². Those with back pain are also more likely to miss out on social activities and report feelings of sadness than those without back pain, per the Georgetown University Health Policy Institute.

Yet lacing up your shoes and going for regular walks has rarely been studied as a possible therapy to prevent the recurrence that 70 percent of those with lower back pain experience within one year of recovery, says Natasha Pocovi, PhD, MPT, a postdoctoral researcher at Macquarie University in Sydney, Australia, and co-author of the WalkBack study.

“Within research and clinical settings, there’s a heavy emphasis on treating low back pain with very little attention turned to prevention,” Dr. Pocovi says. “This is such an important part of managing low back pain considering its recurrent nature—and I think it’s something we could be doing better.”

Read on to find out more about the benefits of walking for back pain and how much of it you might need to do to see results.

How walking might help ease your back pain

While it’s understandable not wanting to move much if you have back pain, being sedentary is one of the worst things you can do, says Colleen Louw, MPT, a spokesperson for the American Physical Therapy Association and program director for the Therapeutic Pain Specialist Certification for Evidence In Motion, an educational institution for health care professionals.

“Immobility can cause a plethora of issues,” Louw says. “If you’re in one position for too long, it loads certain tissues, which can cause them to become strained. Strained tissues are more vulnerable to injuries.”

On the other hand, physical activity like walking is beneficial both for general health and healing.

“Movement brings blood flow to tissues and increases oxygenation needed for healing,” Louw says. “Movement not only brings nutrients to tissues, it also produces endorphins, or ‘happy chemicals,’ that help us feel better. The more you move, the better you feel.”

During the WalkBack study’s 12- to 36-month follow-up period, those in the walking program were 28 percent less likely to experience a recurrence of activity-limiting back pain and 43 percent less likely to have back pain that required them to seek care than those not in the walking program.

For those with low back pain, walking is ideal because it’s low impact, which can help ease concerns about pain and reinjury, according to Dr. Pocovi. In a small 2023 study in the Journal of Physiotherapy³, co-authored by Dr. Pocovi, those with lower back pain reported being nervous about doing high-impact exercise, but considered walking a safe exercise option.

“Many of those who [experience] recurrent back pain naturally have fears and hesitations related to exercise, particularly any exercise that is deemed high impact or high intensity,” Dr. Pocovi says. “This is why walking was very appealing to participants in our intervention and was generally considered safe.”

The WalkBack trial noted most exercise-based interventions studied for lower back pain so far have involved equipment, clinical supervision, and high cost. On the other hand, walking doesn’t require more than investing in a good pair of shoes and can be done just about anywhere.

“Regarding cost-effectiveness, walking requires no equipment and minimal supervision—or none in many cases—making it a much more accessible exercise format for individuals experiencing recurrent low back pain,” Dr. Pocovi says.

While the walking itself was important to easing back pain, the WalkBack trial provided the walking program group with six educational and coaching sessions with a physical therapist, which also played a role in the results. The education and reassurance provided by PTs was empowering and allowed participants to better self-manage their pain and reduce their reliance on health care providers, Dr. Pocovi explains.

“We know that physical activity behavior, or lack thereof, is a hard habit to change,” she says. “Use of the clinician [physical therapist] allowed for a sense of accountability for those in the walking program, and the monitoring of injuries and sensible progression of the walking program, as well as delivery of the education program, were all components we believe were essential to the program’s success.”

While you might not immediately associate PTs with walking programs, Louw says they can be an important resource providing everything from evaluation, assessments, and medical screenings to ongoing education, support, and injury-prevention strategies. The Journal of Physiotherapy study found those who recently recovered from low back pain reflected positively on a physiotherapist-prescribed walking program for factors such as accountability and motivation.

“For many people, fear can immobilize them. They’re afraid if they move, they’ll hurt something,” Louw says. “That’s when we educate them about what’s going on physically, that they might be sore but it’s still safe and okay to move despite the pain. We are highly trained and educated, and we love to develop long-term relationships with clients.”

“Movement brings blood flow to tissues and increases oxygenation needed for healing. Movement not only brings nutrients to tissues, it also produces endorphins, or ‘happy chemicals,’ that help us feel better. The more you move, the better you feel.” —Colleen Louw, MPT

How much do you need to walk to see results?

The WalkBack trial’s walking group worked up to an average of walking three to five days a week for a total of 130 minutes per week by the third month of the trial.

“This seems a sensible dose to recommend based on our study findings,” Dr. Pocovi says.

Louw says those numbers fall in line closely with the American College of Sports Medicine Physical Activity Guidelines, which recommend 30 minutes of moderate-intensity activity at least five days a week. However, some people will have to work up to walking that much—something a PT can help you do safely so you avoid injury, she adds.

“PTs will help you to do more activity as you are able,” Louw says. “Some people might feel great and decide to walk three miles. Then they end up back in bed. We want to expose you to gradual activity.”

Will your back pain come back if you stop walking?

If walking helps back pain from recurring, the obvious question is whether the pain will return if you stop walking regularly. There’s a good chance it will, according to both Louw and Dr. Pocovi.

“For most intervention effects to be long lasting, it’s believed you need to sustain or continue engagement into the long term. We assume it’s no different in this instance,” Dr. Pocovi says.

Participants in the small Journal of Physiotherapy study “voiced that if they waivered in their compliance with the walking program, they might feel a small ‘niggle,’ and this motivated re-engagement with the program. This nicely talks to the need for ongoing engagement for sustained benefit,” Dr. Pocovi says.

In other words, if walking has been successful at keeping your back pain at bay, you probably should keep doing it.

“If movement is helping and the pain is going away, then you quit walking and it comes back, you know you need to continue that movement,” Louw says.

Safety considerations for walking for lower back pain

While most people can safely start a walking program, anyone with pre-existing conditions—particularly those with cardiovascular or balance issues or who are older—should get the green light from their doctors first, Louw advises.

PTs can provide ongoing medical screenings, work closely with physicians, and help those who can’t yet start a walking program work toward safely doing so, she adds.

Once you start a program, it’s important to progress slowly to avoid injury, along with being aware of weather conditions if you’re going to walk outside, Louw says.

“Weather can be a limiting factor, especially for older people. If you live in a place where it snows, you may need to go to the gym and walk on the treadmill for three months,” she says.

If you experience any back pain as you’re walking, that doesn’t necessarily mean you need to quit your walking program, although you might need to cut back or be reassessed if the pain continues, Louw advises.

“Listen to your body,” she says. “If you start feeling back pain, that might be all you should walk for the day, but that doesn’t mean you need to stop if there’s no medical reason. The [WalkBack] study showed walking won’t make you worse. Remember: Physiologically, immobility strains tissues more than mobility.”