We know that exercise on the whole is beneficial for low back pain.

 

But what about running?  Isn’t running “high impact” and risky for an aching back?

 

In my personal experience when my back is sore, the last thing I want to do is go for a jog or a run.

 

And as a clinician I have at times steered my low back pain patients away from running fearing it may aggravate or irritate their low back pain.  And I certainly have directed patients to alternative exercise options that may be “safer” in the meantime.

 

But does my personal (and clinical) bias need to be re-evaluated?

 

A brand new, high quality, Australian trial has demonstrated that an individualized and conservative run-walk program should be considered as a suitable form of activity for adults with chronic low back pain.

 

The trial randomized 40 people with chronic mechanical low back pain to either a 12 week run-walk interval program or a waitlist control.  The progressive running program was a digitally delivered program consisting of 3, 30 minute sessions, per week.

 

Individuals started the program in either Stage 1, 2 or 3 and could progress up to one stage per week if they were able to complete the upper end of the repeats (10) for at least 2 sessions.

 

 

 

Study participants also had control over whether they preferred staying at a stage or regressing to a lower stage.

 

Participants were encouraged to run at slow or moderate speeds on flat terrain and to walk at a self selected pace.

 

Differences in pain intensity were found between the intervention and contol group at both 6 and 12 weeks.  The mean difference in current pain intensity from baseline to 12 weeks was 16.55 (from 30.8 to 14.25) and the mean different in disability from baseline to 12 was 6.9 (from 20.8 to 13.9) compared to an insignificantly changed pain and disability in the control group.

 

 

 

Quite simply, those in the run/walk program got better after 6 and 12 weeks, but those in the control group did not.

 

So is running a good treatment option for low back pain?

 

For patients with chronic low back pain with lower baseline levels of pain and disability, results from this trial may provide some credibility to a progressive run/walk program to treat low back pain.

 

The authors however settled on a more moderate conclusion and state that despite the run program being safe, it is unclear if it should be recommended as an intervention for chronic low back pain as pre determined clinically significant change thresholds were not attained in this study (20 points on the pain scale and 10 points on the disability scale).  But those thresholds may have been a reach in this study when baseline starting levels of pain started around 30 and disability around 20.

 

The real value in this study is opening the door to further discussion and study on the types of low back pain patients and cases that might benefit from a specific progressive run-walk approach in cases.  That is a slow, controlled increase in running volume and intensity.

 

For better clinical results, our clinical recommendations need to get more specific.  And the stages suggested in the above study provide a great strategic framework.  From as little as 4.5 minutes of running in a week, there is likely an intensity here that almost any patient can get started.

 

Runners want to run

 

Since participants were primarily recruited via facebook and instagram ads, there likely is a self selection bias at play in this study.

 

But this is clinical reality as well.  Patient’s who love to run often seek permission from therapists and clinicians to get back to running.  At the very least this study should be pause for any knee jerk clinical recommendation of “absolutely no running”.

 

Running as another tool

 

This study in no means says running is better than other exercise options (ie. yoga, cycling or resistance training).  No such comparisons were made in this study.  A progressive run/walk program may just be another option for low back pain sufferers to get more active.

 

Like any other form of exercise.  Start slow, build confidence and increase intensity and volume as tolerated.

 

Runners have been shown to have a low prevalence and incidence of low back pain relative to the general population.

 

So maybe running can be both protective and therapeutic for low back pain?

 

It’s time we (including me) stop vilianizing running as a risky “high impact activity” for patients with low back pain.