Lower back pain is extremely common, and most people will experience it at some point in their lives. One time when many individuals feel this pain is during long walks.
Factors for Back Pain while walking
Back pain while walking can be caused by several factors. These include:
- Poor Hip Mobility: If your hip lacks motion in any direction, your lower back may compensate by moving more than it’s designed to, leading to inflammation and compression of the nerves that exit the spine[1].
- Decreased Hip Strength: Weak lateral muscles of the hip can cause a slight lean to one side when walking, which can lead to back pain[1].
- Limited Foot and Ankle Mobility: If your foot is stiff and doesn’t flatten when you walk, increased forces are transmitted to your spine, which can irritate the joints and nerves in the spine[1].
- Spine Arthritis and/or Stenosis: If you’re over 55 and have pain in your lower back with walking or standing that goes away when you sit, there’s a high chance you have arthritis in your spine[1].
- Muscle Fatigue or Injury: Prolonged walking or standing can tire or strain the muscles in the lower back and legs, leading to aches and pains[4].
- Poor Posture: The way you walk can also lead to lower back pain. A straight spine ensures your body is distributing your weight evenly with each step[5].
- Stress: Standing or walking for long periods of time places stress on your lower back. In addition to the actual pressure on lumbar vertebrae, if you’re standing at a high-demand job, your back muscles may tense as well, increasing the pain[7].
When it comes to chronic or recurrent lower back pain, especially during walking, the main factor is likely stiffness and lack of control and movement of the trunk (lumbo-pelvic control). As the back becomes stiffer, muscles begin to work separately instead of together. The lumbar muscles tighten to add stability, but this leads to even more stiffness and discomfort.
Stress and anxiety also play a significant role. If a person feels anxious or afraid of walking long distances due to previous pain experiences, this sends signals to the brain to protect the area by stiffening the muscles. This perpetuates the cycle of pain and stiffness.
Furthermore, if someone has had an injury, such as in the hip or knee joint, the body tends to compensate by changing the walking pattern to avoid pain. Over time, this new, less natural pattern can overburden the lower back.
Treatment Options
Treatment options include physical therapy, which can teach exercises to increase flexibility, strengthen back and abdominal muscles, and improve posture[2]. Regular use of these techniques can help keep pain from returning. Other treatments include over-the-counter pain relievers, hot or cold therapy, gentle stretching, and maintaining a moderate weight[4]. In some cases, surgical procedures like cortisone injections may be recommended[2].
Preventive measures include adjusting your workstation for better ergonomics, losing weight to reduce stress on the back, and practicing proper footwork and posture while walking[5][7]. Regular exercise, such as walking, swimming, and biking, can also help reduce back pain[6].
The type of footwear is also important. Shoes without adequate support or with high heels can limit toe extension or calf activation, requiring compensation elsewhere like the hips and back. This alters biomechanics and strains the lower back.
Some recommendations for improving lumbo-pelvic control and relieving back pain while walking include:
- Isometric strengthening of the oblique and adductor muscles
- Bridge exercises to work the glutes and hamstrings
- Upper back mobility with exercises like the “open book”
- Unipodal exercises to develop control and proprioception
- Appropriate footwear that allows toe extension and calf activation
- Awareness and variation of walking patterns
Possible exercises
First Exercise – Posterior Pelvic Tilt
The first exercise involves lying on your back with knees bent and shoulders relaxed. Try to create a gap in the lower back region by pushing the hip towards the ground while inhaling and exhaling. Aim to maintain this posterior pelvic tilt for 5 seconds and then relax. Repeat this a few times. This exercise helps to activate the muscles instead of keeping them overly tense.
Second Exercise – Pelvic Tilt with Arm Raise
This is a progression of the previous exercise. Maintain the posterior pelvic tilt for 5 seconds and then slowly raise your arms above your head while keeping the pressure on the hip. You can use a stick or small bar to add weight to the arms. Perform 3 sets of 5 repetitions.
Third Exercise – Standing Against the Wall
Stand against the wall with knees slightly bent. Keep your shoulders and head against the wall. Try to push the lower back region towards the wall to create the posterior pelvic tilt. Hold for 5 seconds while breathing and then relax. Do 3 sets of 5 repetitions. This exercise helps the lumbar muscles to become more coordinated with movement.
Fourth Exercise – With Resistance Band
Place a resistance band around your waist and stand against the wall. Perform the posterior pelvic tilt and hold for 5 seconds. Then slowly raise your arms above your head and hold again for 5 seconds. Bring your arms down and relax. Repeat in a comfortable range of motion and gradually increase. The goal is to coordinate the posterior pelvic tilt movement and be able to breathe normally.
Mobility
Addressing control and mobility holistically, from the foot to the spine, can help alleviate lower back pain associated with walking. Factors such as stress and injury compensation also need to be considered. By modifying movement patterns and footwear choices, many individuals can find relief.
Prognosis
If home treatments aren’t working after several weeks, or if the pain is severe, does not get better, or occurs along with other concerning or debilitating symptoms, it’s recommended to see a healthcare provider[2][4].
Citations:
[1] https://www.kineticedgept.com/5-reasons-why-your-back-hurts-when-you-walk/
[2] https://www.mayoclinic.org/diseases-conditions/back-pain/diagnosis-treatment/drc-20369911
[3] https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/back-pain/art-20546859
[4] https://www.medicalnewstoday.com/articles/325434
[5] https://healthmatch.io/lower-back-pain/lower-back-pain-when-standing
[6] https://www.webmd.com/back-pain/ss/slideshow-exercises
[7] https://www.dfwback.com/lower-back-hurts-when-walking-or-standing/
[8] https://painandspinespecialists.com/lower-back-pain-when-walking/amp/
[9] https://www.nhsinform.scot/illnesses-and-conditions/muscle-bone-and-joints/exercises/exercises-for-back-pain/
[10] https://www.mayoclinic.org/diseases-conditions/back-pain/symptoms-causes/syc-20369906
[11] https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=ut3391
[12] https://www.aarp.org/health/conditions-treatments/info-2022/exercises-for-lower-back-pain.html
[13] https://www.mayoclinic.org/symptoms/back-pain/basics/causes/sym-20050878
[14] https://www.webmd.com/back-pain/understanding-back-pain-treatment
[15] https://youtube.com/watch?v=DxIeqiyYZkQ
[16] https://versusarthritis.org/about-arthritis/conditions/back-pain/
[17] https://health.ucdavis.edu/blog/cultivating-health/8-tips-to-help-ease-your-back-pain/2022/06
[18] https://www.thespineandrehabgroup.com/lower-back-pain-when-walking
[19] https://www.healthline.com/nutrition/stretches-for-lower-back-pain
[20] https://www.niams.nih.gov/health-topics/back-pain
[21] https://www.sciatica.com/blog/best-exercises-to-help-with-back-pain/
MD, PhD. Physical Medicine & Rehabilitation Physician from São Paulo - Brazil. Pain Fellowship in University of São Paulo.