Walking and Unloading Your Spine

Yes, you read that right: walking is so important that it gets its own section, with a couple of other goodies too. Research recommends walking as the baseline activity for people with back pain [1].

Why walking?

Walking is particularly useful when dealing with back pain and flare-ups because:

• Walking is how we get around, and that's worth protecting
• It's low impact
• It's easily scalable: short walks, long walks, fast walks, slow walks
• It requires no equipment
• It keeps us mobile
• It relieves back pain for some

There's also a biomechanical basis for recommending walking. Walking provides:

• Low-rate rhythmic forces that load and unload the spine
  • This loading pattern enhances nutrient transport to our intervertebral discs [2]
• A free arm swing that "dampens" the rotational forces on your trunk and head [3]
  • Patients with disc herniations tend to stiffen their posture while walking and stop swinging their arms freely, which may unintentionally cause greater rotational forces on the spine [4]

How to walk with back pain

I bet you never thought you'd be told how to walk again. Well, you bet wrong.

• Let your arms swing naturally, which reduces the rotational forces on your spine
• Think about being stable, not rigid
• Start with short bouts of walking, continuing until discomfort, then unload / decompress
• Build up distance and speed over time

The pattern is simple: walk a comfortable distance, decompress for a few minutes (as needed), and walk again when symptoms settle. Repeat.

Unloading / decompression techniques

Counter-top decompression

1. Stand facing a sturdy bench, table, or countertop that is around hip height.
2. Place your hands or forearms on the surface, then offload your weight onto it. It helps to turn your palms forward and not let your shoulders shrug.
3. Let your knees soften slightly and allow your arms to support some of your bodyweight. If the surface is stable, you may fully offload your weight onto it.
4. Breathe slowly and feel your low back gently unload. Hold for 30-60 seconds, or however long feels comfortable, then slowly walk your feet back in and stand up tall.

Counter-top decompression

Lying with legs up (90/90 position)

1. Lie on your back and rest your lower legs on a chair or couch.
2. Form a 90-degree angle at your hips and knees.
3. Rest and remain still for a few minutes.
4. Repeat as needed.

Legs-up 90/90 decompression

This position unloads the posterior elements of the spine in a safe, stable way, but it is less accessible and portable than the counter-top decompression.

References

• [1] Vanti et al. (2019). https://doi.org/10.1080/09638288.2017.1410730
• [2] Gullbrand et al. (2015). https://doi.org/10.1097/BRS.0000000000001012
• [3] Pontzer et al. (2009). https://doi.org/10.1242/jeb.024927
• [4] Huang et al. (2011). https://doi.org/10.1007/s00586-010-1639-8