Increased Walking Time Found to Lower Risk of Low Back Pain

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Hey There! Today’s post will look at reducing your risk of Low Back Pain (LBP), one of the most common conditions worldwide. Some researchers have found the average lifetime prevalence of LBP to be upwards of 38.9% and “most prevalent among females and persons ages 40–80 years” (1). While other researchers report that upwards of 80% of Americans will “experience at least one episode of back pain during a lifetime" (2).

Nonetheless, the prevalence is high, while the cost and burden is also significant. However, results of a recent study have found an association between walking and LBP. Researchers discovered that in a general population over 50 years old, “walking for more than 3 days per week for over 30 min at a time was negatively associated with LBP” and “similarly, walking for more than 5 days per week for over 1 h at a time was [also] negatively associated with LBP” (3).

it is also important to note that low back pain and pain in general is multifactorial and the sensation of pain extends far greater than an actual physical injury. Factors such as stress, anxiety, fear, poor sleep habits, and physical inactivity can all contribute to the presence of pain. Now if you find that walking doesn’t help, don’t worry, other forms of physical activity or exercise should still be your first line of defense. Most episodes of acute LBP have actually been found to resolve on there own, just keep moving and don’t limit your activity.

Though, if you still find your LBP has not resolved, seeing a Physical Therapist FIRST has proven time and time again to be the most appropriate path of care. Findings from a most recent study found “that seeing a PT First for a LBP episode significantly lowered the probability of having an opioid prescription, advanced imaging service, and ED visits compared to patients that did not” (4), which are similar in findings to many other studies (5,6).

Until next time,

Fuel Physio Team

  1. Hoy, D., Bain, C., Williams, G., et al. (2012). A systematic review of the global prevalence of low back pain. Arthritis & Rheumatism, 64(6), 2028-2037.

  2. Rubin, D. I. (2007). Epidemiology and risk factors for spine pain. Neurologic clinics, 25(2), 353-371.

  3. Park, S. M., Kim, G. U., Kim, H. J., et al. (2018). Walking more than 90 minutes/week was associated with a lower risk of self-reported low back pain in persons over 50 years of age: A cross-sectional study using the Korean National Health and Nutrition Examination Surveys. The Spine Journal.

  4. Frogner, B. K., Harwood, K., Andrilla, C. H. A., et al. (2018). Physical Therapy as the First Point of Care to Treat Low Back Pain: An Instrumental Variables Approach to Estimate Impact on Opioid Prescription, Health Care Utilization, and Costs. Health services research.

  5. Childs, J. D., J. M. Fritz, S. S. Wu, T. W. Flynn, R. S. Wainner, E. K. Robertson, F. S. Kim, and S. Z. George. 2015. “Implications of Early and Guideline Adherent Physical Therapy for Low Back Pain on Utilization and Costs.” BMC Health Ser- vices Research 15: 150–160.

  6. Fritz, J. M., G. P. Brennan, and S. J. Hunter. 2015. “Physical Therapy or Advanced Imaging as First Management Strategy Following a New Consultation for Low Back Pain in Primary Care: Associations with Future Health Care Utilization and Charges.” Health Services Research 50 (6): 1927–1940.

Updated 2018 Physical Activity Guidelines

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Hey there! We’ve got some big news to share this week! The federal guidelines for physical activity recommendations have just been updated for the first time in 10 years! But guess what, not much as changed. The foundation of the recommendations still suggest a minimum of 150 minutes of moderate-intensity physical activity and muscle-strengthening activities two or more days a week.

However, the new guidelines have a few new emphasizing points and key guidelines for specific populations, such as specifics to preschool-aged kids, older adults, and adults with disabilities. For example:

“Preschool-aged children (3 through 5 years) should be physically active throughout the day to enhance growth and development. Adult caregivers of preschool-aged children should encourage active play that includes a variety of activity types.”

“Children and adolescents aged 6 through 17 years should do 60 minutes (1 hour) or more of moderate-to-vigorous physical activity daily.”

For adults, “additional health benefits are gained by doing physical activity beyond the equivalent of 300 minutes (5 hours) of moderate-intensity physical activity a week.”

“As part of their weekly physical activity, older adults should do multicomponent physical activity that includes balance training as well as aerobic and muscle-strengthening activities.”

“When adults with chronic conditions or disabilities are not able to meet the above key guidelines, they should engage in regular physical activity according to their abilities and should avoid inactivity.”

In addition, there are recommendations for “Safe Physical Activity,” including:

“Increase physical activity gradually over time to meet key guidelines or health goals. Inactive people should “start low and go slow” by starting with lower-intensity activities and gradually increasing how often and how long activities are done.”

“Protect themselves by using appropriate gear and sports equipment, choosing safe environments, following rules and policies, and making sensible choices about when, where, and how to be active.”

“Be under the care of a health care practitioner if they have chronic conditions or symptoms. People with chronic conditions and symptoms can consult a health care professional or physical activity specialist about the types and amounts of activity appropriate for them.”

The guidelines also do a great job at highlighting the many known health benefits of physical activity. The list is pretty extensive, so be sure to check out the guidelines in its entirety. But it includes health benefits for which there is fairly new evidence for, such as “improved bone health and weight status for children aged 3 through 5 years,” “brain health benefits, including improved cognitive function, reduced anxiety and depression risk, and improved sleep and quality of life,” and “for people with various chronic medical conditions, reduced risk of all-cause and disease-specific mortality, improved function, and improved quality of life.”

The real take home message is that we need to move more, move often, and that all movement counts. Also remember that your physical activity minutes do not need to be completed consecutively, but can be added up over time!

Until next time,

Fuel Physio Team

Physical Activity Guidelines & Walking Pace

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Hey there! And welcome to a long overdue blog post from the Fuel Physio Team. We'll be honest in saying that most of our efforts in writing have gone towards Wellfie Wednesday Tips. If you haven't seen those or know what they are, check them out!

Lets talk physical activity guidelines and how the aerobic component can be obtained with just simply walking throughout the week. No gym equipment necessary! So the recommended amount for sustained health benefits are as follows, and these can be found in greater detail here. 

  • 150 minutes a week of moderate-intensity aerobic physical activity
  • 75 minutes a week of vigorous-intensity aerobic physical activity
  • The guidelines also emphasize muscle-strengthening activities of moderate or high intensity, involving all major muscle groups, for 2 or more days a week

Now that we know our recommended time to reap all the amazing benefits of physical activity, how can we achieve the recommended intensity? Well, lets look at moderate-intensity. The guidelines do actually mention "brisk walking" as an example. But exactly is "brisk walking?" There was an article published earlier this year in the British Journal of Sports Medicine that looked at just that. They determined that an absolute threshold of moderate-intensity occurs with a walking pace or cadence of >100 steps/min. However, know that even at a slower cadence, health benefits can still be had.

This link from the CDC provides other examples of obtaining moderate or vigorous intensities. Including mention of the "talk test." Where during an activity if you unable to speak a few words without pausing for a breath, your activity is most likely of vigorous-intensity.

Until next time,

Fuel Physio Team

Two Weeks of Ergonomic Fun! Few Key Points

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     Hey, everyone. This is going to be hopefully a real informal post about my ergonomic experiences the past two weeks. So lets dive right in. Last week I took the CEAS I: Ergonomics Assessment Certification Workshop to get my CEAS (Certified Ergonomics Assessment Specialist) credentials, which was followed up by attending the 16th Annual Applied Ergonomics Conference these past few days. So to say the least, I learned about ergonomics and then truly learned about ergonomics. I want to share mainly a few of the things that popped out these past two weeks.

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     One of the main reasons I love the concept of ergonomics is because it revolves around preventing injury. It’s about making a work environment that fits the employee while reducing their fatigue, stress, and risk of injury. The most important thing to remember is that we are all of different shapes and sizes, so a one size fits all workplace design does not work. Ergonomic setup needs to be individualized, and that doesn’t mean using a tool or buying a chair that’s labeled “ergonomic.” The practice of ergonomics is very detailed and after the things I saw this week, it is highly engineering oriented. But we as physical therapists can surely be a part of it. 

Sitting vs. Standing

     So there has been a lot of talk recently about the benefits of standing instead of sitting all day. Well, I’m sorry to tell you that there is not any strong research to support this, and none of the professional ergonomists are recommending to stand all day long. But what they do recommend is being ACTIVE during your workday and taking “ergo breaks.” 

     During one of the conference sessions, John Kerst shared “5 Ways to Make Your Desk Job Less Sedentary.”

  • Alternative Workstation (Sit to stand or lean to stand)
  • Coffee & Water Cup Size (Decreasing coffee size or increasing water, more bathroom trips)
  • Try Walking Meetings (Said to increase brain activity)
  • Integrate Technology Assist (Step counter, Fitbit, alarms to get up)
  • Vary Your Posture
    • 20 minutes of leaning/sitting
    • 8 minutes of active standing (weight shifting)
    • 2 minutes of walking around)
  • Education (Increase knowledge deficits on posture and physical fitness)

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“Ergo breaks” can consist of getting up and moving around, as well as targeted stretches depending on your occupation. 

Work in the Perfect Zone!

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     Another speaker, Ben Zavitz, gave 10 “Everyday Ergonomic Solutions.”

  1. Get things off the floor
  2. Raise the employee
  3. Use a wheel or roller
  4. Lighten the load (material substitution or weight distribution)
  5. Use mechanical assistance/ leverage
  6. Tilt the workstation
  7. Extend the tool
  8. Use ergonomically engineered tools (it’s the features, not the name)
  9. Daily oiling and preventative maintenance
  10. Design hands-free options

     Education needs to be blended, especially when training for operations and safety. Kent Hatcher’s presentation, “Utilizing Blended Learning to Provide Effective Ergonomics Training,” pointed out the deficits in training an employee exclusively by computer-based technology or classroom setting. Practice makes perfect. He shared the 70:20:10 rule from the Center for Creative Leadership. Learning is 70% hands-on problem solving, 20% feedback and networking, and 10% classroom/ coursework.

     Every session that I attended and every speaker that I listen to had one thing in common, and that was addressing the issue early will yield the greatest outcomes. If a job looks like it may be harmful, puts an employee in an awkward position, or requires continuous repetition, make adjustments before an injury occurs.

    There was also a big focus on wellness and the implementation of various types of programs within companies around the world. Being an area that I wish to practice in, there will be many future posts regarding this topic. I hope you found some of this information interesting. All the credit goes to the presenters of the 16th Annual Applied Ergonomics Conference and CEAS instructors. 

Thanks for reading!

- Patrick Berner, SPT, CEAS