Posts tagged walking
Impact Of Walking On Chronic Low Back Pain
walking-exercise-chronic-pain-low back pain

Low back pain remains the most common musculoskeletal diagnosis seen by primary care providers including Physical Therapists. While the majority of cases of low back pain are not serious in nature symptoms tend to be recurrent and can become chronic (> 3 months) if left untreated. As low back pain progresses from acute to chronic in nature changes in the both the peripheral and central nervous systems can occur leading to increased symptoms and loss of function. Patients with signs and symptoms consistent with nervous system changes are often prescribed pain science education and graded exercise to improve their symptoms and most importantly participation in life, work, and recreational activities. A recent review of the research examines the impact of walking vs. general exercise on patients with chronic low back pain.

Vanti and colleagues reviewed the available research on the effects of walking alone compared to exercise, as well as, the impact of the addition of walking to other forms of exercise (Disabil Rehabil. 2019). They reviewed 5 randomized controlled trials on the topic and make recommendations based off this evidence. In general, most forms of exercise including walking, showed a positive effect on a patient’s low back pain, fear of activity, and disability. Authors noted walking was not superior to other forms of exercise, but may be more easily implemented because of its’ ease of implementation compared to other forms of exercise. This study confirms prior research advocating for increasing the activity levels of patients with chronic back pain.

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No Additional Benefit Of Orthotics Over Shoes Alone

We have previous discussed the limitations of orthotics to control lower extremity alignment.  Another common reason for orthotic use is to control the degree of pronation or flattening of the foot during foot strike in walking and running.  The theory believes orthotics are able to impact force absorption by controlling this motion at the foot and ankle joints.  Much of this theory is based off an "ideal" neutral position of the foot and ankle called subtalar neutral.  The research into subtalar neutral is conflicting and this position may not be optimal for either static or dynamic foot function.

A recent article in the Medicine and Science in Sport and Exercise journal examined asymptomatic participants with flat feet.  These participants were given custom orthotics based on the sub talar neutral theory.  Each participant then walked at a preferred and fast speed under 3 conditions: barefoot, athletic shoe, and athletic shoe plus orthotic.  Authors measured force and EMG data during each condition.  Results demonstrated the effects of reduced pronation and energy absorption were similar between shoe and shoe and orthotic conditions indicating no further benefit of orthotic use.  Authors reported the benefits of reduced pronation (flattening) and force transmission were due to primarily to shoe wear.