Walking can prevent low back pain, a new study shows
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Do you suffer from low back pain that recurs regularly? If you do, you’re not alone. Roughly 70% of people who recover from an episode of low back pain will experience a new episode in the following year.
The recurrent nature of low back pain is a major contributor to the enormous burden low back pain places on individuals and the health-care system.
In our new study, published today in The Lancet, we found that a program combining walking and education can effectively reduce the recurrence of low back pain.
The WalkBack trial
We randomly assigned 701 adults who had recently recovered from an episode of low back pain to receive an individualised walking program and education (intervention), or to a no treatment group (control).
Participants in the intervention group were guided by physiotherapists across six sessions, over a six-month period. In the first, third and fifth sessions, the physiotherapist helped each participant to develop a personalised and progressive walking program that was realistic and tailored to their specific needs and preferences.
The remaining sessions were short check-ins (typically less than 15 minutes) to monitor progress and troubleshoot any potential barriers to engagement with the walking program. Due to the COVID pandemic, most participants received the entire intervention via telehealth, using video consultations and phone calls.
The program was designed to be manageable, with a target of five walks per week of roughly 30 minutes daily by the end of the six-month program. Participants were also encouraged to continue walking independently after the program.
Importantly, the walking program was combined with education provided by the physiotherapists during the six sessions. This education aimed to give people a better understanding of pain, reduce fear associated with exercise and movement, and give people the confidence to self-manage any minor recurrences if they occurred.
People in the control group received no preventative treatment or education. This reflects what typically occurs after people recover from an episode of low back pain and are discharged from care.
What the results showed
We monitored the participants monthly from the time they were enrolled in the study, for up to three years, to collect information about any new recurrences of low back pain they may have experienced. We also asked participants to report on any costs related to their back pain, including time off work and the use of health-care services.
The intervention reduced the risk of a recurrence of low back pain that limited daily activity by 28%, while the recurrence of low back pain leading participants to seek care from a health professional decreased by 43%.
Participants who received the intervention had a longer average period before they had a recurrence, with a median of 208 days pain-free, compared to 112 days in the control group.
Overall, we also found this intervention to be cost-effective. The biggest savings came from less work absenteeism and less health service use (such as physiotherapy and massage) among the intervention group.
This trial, like all studies, had some limitations to consider. Although we tried to recruit a wide sample, we found that most participants were female, aged between 43 and 66, and were generally well educated. This may limit the extent to which we can generalise our findings.
Also, in this trial, we used physiotherapists who were up-skilled in health coaching. So we don’t know whether the intervention would achieve the same impact if it were to be delivered by other clinicians.
Walking has multiple benefits
We’ve all heard the saying that “prevention is better than a cure” – and it’s true. But this approach has been largely neglected when it comes to low back pain. Almost all previous studies have focused on treating episodes of pain, not preventing future back pain.
A limited number of small studies have shown that exercise and education can help prevent low back pain. However, most of these studies focused on exercises that are not accessible to everyone due to factors such as high cost, complexity, and the need for supervision from health-care or fitness professionals.
On the other hand, walking is a free, accessible way to exercise, including for people in rural and remote areas with limited access to health care.
Walking also delivers many other health benefits, including better heart health, improved mood and sleep quality, and reduced risk of several chronic diseases.
While walking is not everyone’s favourite form of exercise, the intervention was well-received by most people in our study. Participants reported that the additional general health benefits contributed to their ongoing motivation to continue the walking program independently.
Why is walking helpful for low back pain?
We don’t know exactly why walking is effective for preventing back pain, but possible reasons could include the combination of gentle movements, loading and strengthening of the spinal structures and muscles. It also could be related to relaxation and stress relief, and the release of “feel-good” endorphins, which block pain signals between your body and brain – essentially turning down the dial on pain.
It’s possible that other accessible and low-cost forms of exercise, such as swimming, may also be effective in preventing back pain, but surprisingly, no studies have investigated this.
Preventing low back pain is not easy. But these findings give us hope that we are getting closer to a solution, one step at a time.
Tash Pocovi, Postdoctoral research fellow, Department of Health Sciences, Macquarie University; Christine Lin, Professor, Institute for Musculoskeletal Health, University of Sydney; Mark Hancock, Professor of Physiotherapy, Macquarie University; Petra Graham, Associate Professor, School of Mathematical and Physical Sciences, Macquarie University, and Simon French, Professor of Musculoskeletal Disorders, Macquarie University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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The Big Book of Kombucha – by Hannah Crum & Alex LaGory
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If you’ve been thinking “I should get into kombucha”, then this is the universe prompting you, because with in this book’s 400 pages is all the information you need and more.
Because, it’s understandable to be wary when starting out, from “what if my jar explodes” to “what if I poison my family”, but the authors (and photographer) take every care to ensure that everything goes perfectly, guiding us through everything from start to finish, including very many high-quality color photos of what things should (and shouldn’t) look like.
On which note, that does mean that to enjoy the color you should get a physical copy or Kindle Fire, not a Kindle e-ink version (as then it’d be black and white).
There’s also a comprehensive section on troubleshooting, as well as hundreds of recipes for all kinds of flavors and occasions.
Bottom line: in the category of books that could reasonably be called “The Bible of…”, this one’s the “The Bible of Kombucha”.
Click here to check out The Big Book Of Kombucha, and get brewing!
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Hormone Replacement
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It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝I cant believe 10 Almonds addresses questions. Thanks. I see the word symptoms for menopause. I don’t know what word should replace it but maybe one should be used or is symptom accurate? And I recently read that there was a great disservice for women in my era as they were denied/scared of hormones replacement. Unnecessarily❞
You’d better believe it! In fact we love questions; they give us things to research and write about.
“Symptom” is indeed an entirely justified word to use, being:
- General: any phenomenon or circumstance accompanying something and serving as evidence of it.
- Medical: any phenomenon that arises from and accompanies a particular disease or disorder and serves as an indication of it.
If the question is more whether the menopause can be considered a disease/disorder, well, it’s a naturally occurring and ultimately inevitable change, yes, but then, so is cancer (it’s in the simple mathematics of DNA replication and mutation that, unless a cure for cancer is found, we will always eventually get cancer, if nothing else kills us first).
So, something being natural/inevitable isn’t a reason to not consider it a disease/disorder, nor a reason to not treat it as appropriate if it is causing us harm/discomfort that can be safely alleviated.
Moreover, and semantics aside, it is medical convention to consider menopause to be a medical condition, that has symptoms. Indeed, for example, the US’s NIH (and its constituent NIA, the National Institute of Aging) and the UK’s NHS, both list the menopause’s symptoms, using that word:
- NIA (NIH): What are the signs and symptoms of menopause?
- NHS: Common symptoms of menopause and perimenopause
With regard to fearmongering around HRT, certainly that has been rife, and there were some very flawed (and later soundly refuted) studies a while back that prompted this—and even those flawed studies were not about the same (bioidentical) hormones available today, in any case. So even if they had been correct (they weren’t), it still wouldn’t be a reason to not get treatment nowadays, if appropriate!
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Fully Present – by Dr. Susan Smalley and Diana Winston
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“The Science and the Art of…” tends to be a bit of a fuzzy obfuscation, but in this case, it’s accurate, especially in this presentation. The authors are, indeed, a scientist and an artist—and both practitioners, meeting in the middle.
As such, we get the clinical insights of a researcher and professor of psychiatry, and the grounded-yet-spiritual insights of an erstwhile Buddhist nun.
While the book is pop psychology in essence, the format is much more that of a textbook than a self-help book. Will it be useful for helping yourself anyway, though? Yes, absolutely, if you apply the information contained within.
Don’t be fooled into thinking that a textbook format makes it dry, though—the writing is very compelling, and you’ll find yourself turning pages eagerly. There’s no time like the present, after all!
Bottom line: if you find the scientific evidence-base for the usefulness of mindfulness appealing, but find a lot of guides a little fluffy, this one is perfectly balanced—and very well written, too.
Click here to check out Fully Present, bring yourself into the moment, always!
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What are house dust mites and how do I know if I’m allergic to them?
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People often believe they are allergic to house dust. But of the 20% of Australians suffereing with allergies, a number are are actually allergic to microscopic house dust mites.
House dust mites belong to the same family as spiders and ticks. They measure just 0.2-0.3 mm, with 50 fitting on a single pinhead. They live for 65–100 days, and females lay 60–100 eggs in their life.
Some 50 house dust mites can fit on one pinhead. Choksawatdikorn/Shutterstock House dust mites love temperate climates and humidity. They feed off the skin cells we and animals shed, as well as mould, which they digest using special enzymes. These enzymes are excreted in their poo about 20 times a day. They also shed fragments of their exoskeletons.
All these fragments trigger allergies in people with this type of allergic rhinitis (which is also known as hay fever)
shuttertock. PeopleImages.com – Yuri A/Shutterstock What are the symptoms?
When people with house dust mite allergy inhale the allergens, they penetrate the mucous membranes of the airways and eyes. Their body recognises the allergens as a threat, releasing chemicals including one called histamine.
This causes symptoms including a runny nose, an itchy nose, eyes and throat, sneezing, coughing and a feeling of mucus at the back of your throat (known as a post-nasal drip).
People with this type of allergy usually mouth breath, snore, rub their nose constantly (creating a nasal crease called the “dust mite salute”) and have dark shadows under their eyes.
House dust mite allergy can also cause poor sleep, constant tiredness, reduced concentration at work or school and lower quality of life.
For people with eczema, their damaged skin barrier can allow house dust mite proteins in. This prompts immune cells in the skin to release chemicals which make already flared skin become redder, sorer and itchier, especially in children.
Symptoms of house dust mite allergy occur year round, and are often worse after going to bed and when waking in the morning. But people with house dust mite allergy and pollen allergies find their year-round symptoms worsen in spring.
How is it diagnosed?
House dust mite allergy symptoms often build up over months, or even years before people seek help. But an accurate diagnosis means you can not only access the right treatment – it’s also vital for minimising exposure.
Your clinician can talk you through treatment options and how to minimise exposure. Monkey Business Images/Shutterstock Doctor and nurse practitioners can order a blood test to check for house dust mite allergy.
Alternatively, health care providers with specialised allergy training can perform skin prick tests. This involves placing drops of the allergens on the arm, along with a positive and negative “control”. After 15 minutes, those who test positive will have developed a mosquito bite-like mark.
How is it treated?
Medication options include one or a combination of:
- daily non-sedating antihistamines
- a steroid nasal spray
- allergy eye drops.
Your health care professional will work with you to develop a rhinitis (hay fever) medical management plan to reduce your symptoms. If you’re using a nasal spray, your health provider will show you how to use it, as people often use it incorrectly.
If you also have asthma or eczema which is worsened by dust mites, your health provider will adapt your asthma action plan or eczema care plan accordingly.
If you experience severe symptoms, a longer-term option is immunotherapy. This aims to gradually turn off your immune system’s ability to recognise house dust mites as a harmful allergen.
Immunotherapy involves taking either a daily sublingual tablet, under the tongue, or a series of injections. Injections require monthly attendances over three years, after the initial weekly build-up phase.
These are effective, but are costly (as well as time-consuming). So it’s important to weigh up the potential benefits and downsides with your health-care provider.
How can you minimise house dust mites?
There are also important allergy minimisation measures you can take to reduce allergens in your home.
Each week, wash your bedding and pyjamas in hot water (over 60°C). This removes house dust mite eggs and debris.
Opt for doonas, covers or quilts that can be washed in hot water above 60°C. Alternatively, low-cost waterproof or leak proof covers can keep house dust mites out.
If you can, favour blinds and wood floors over curtains and carpet. Dust blinds and surfaces with a damp cloth each week and vacuum while wearing a mask, or have someone else do it, as house dust mites can become airborne during cleaning.
But beware of costly products with big marketing budgets and little evidence to support their use. A new mattress, for example, will always be house dust mite-free. But once slept on, the house dust mite life cycle can start.
Mattress protectors and toppers commonly claim to be “hypoallergenic”, “anti-allergy” or “allergy free”. But their pore sizes are not small enough to keep house dust mites and their poo out, or shed skin going through.
Sprays claiming to kill mites require so much spray to penetrate the product that it’s likely to become wet, may smell like the spray and, unless dried properly, may grow mould.
Finally, claims that expensive vacuum cleaners can extract all the house dust mites are unsubstantiated.
For more information, visit healthdirect.gov.au or the Australian Society of Clinical Immunology and Allergy.
Deryn Lee Thompson, Eczema and Allergy Nurse; Lecturer, University of South Australia
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Body Sculpting with Kettlebells for Women – by Lorna Kleidman
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For those of us who are more often lifting groceries or pots and pans than bodybuilding trophies, kettlebells provide a way of training functional strength. This book does (as per the title) offer both sides of things—the body sculpting, and thebody maintenance free from pain and injury.
Kleidman first explains the basics of kettlebell training, and how to get the most from one’s workouts, before discussing what kinds of exercises are best for which benefits, and finally moving on to provide full exercise programs.
The exercise programs themselves are fairly comprehensive without being unduly detailed, and give a week-by-week plan for getting your body to where you want it to be.
The style is fairly personal and relaxed, while keeping things quite clear—the photographs are also clear, though if there’s a weakness here, it’s that we don’t get to see which muscles are being worked in the same as we do when there’s an illustration with a different-colored part to show that.
Bottom line: if you’re looking for an introductory course for kettlebell training that’ll take you from beginner through to the “I now know what I’m doing and can take it from here, thanks” stage.
Click here to check out Body Sculpting With Kettlebells For Women, and get sculpting!
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Policosanol: A Rival To Statins, Without The Side Effects?
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Policosanol (which can be extracted from various sources, but is mostly made from sugar cane extract) is marketed as lipid-lowering agent for improving cholesterol levels, but its research history has not been without controversy:
2001: it works!
After a lot of research in the 1990s, it came out of the gate strong in 2001, with:
❝Policosanol (5 and 10 mg/day) significantly decreased LDL-cholesterol (17.3% and 26.7%, respectively), total cholesterol (12.9% and 19.5%), as well as the ratios of LDL-cholesterol to high-density lipoprotein (HDL)-cholesterol (17.2% and 26.5%) and total cholesterol to HDL-cholesterol (16.3% and 21.0%) compared with baseline and placebo❞
This, by the way, is comparable in efficacy to the most powerful statins, but without the adverse side effects.
Source: Efficacy and tolerability of policosanol in hypercholesterolemic postmenopausal women
Furthermore, its effects were not limited to postmenopausal women, and additionally, it was found that 20mg/day was sufficient for optimal effects; 40mg worked exactly the same as 20mg:
2006–2010: we do not trust the Cubans!
After it had been marketed and used in much of the world for some years, extra scrutiny was brought upon it, because the initial studies had been performed by the same lab in Cuba, a commercial lab that had tested them for a private interest (i.e., a company selling the supplement):
Heart Beat: Policosanol: A sweet nothing for high cholesterol
And furthermore, US-based labs were unable to replicate the results:
Policosanols as Nutraceuticals: Fact or Fiction
The Cuban researchers countered that the composition of policosanol as produced in their lab was different than the composition of the policosanol as produced in the US labs, because of the purity of the ingredients used in the Cuban lab.
Which, on the face of it, could be true or could just be the claim of a commercial lab with an association with a company selling a product.
Of course, importing Cuban ingredients to test them in the US was not a reasonably accessible option for the US-based labs, because of the US’s embargo of Cuba. In principle it could be done, but unless there is already a huge clear profit incentive, research scientists are usually on their hands and knees begging for grants already, so getting extra funding for specially-important Cuban ingredients was not going to be likely.
2012: never mind, it does work after all!
An American meta-analysis of 4596 patients from 52 eligible studies (from around the world, so many of them not affected by the US’s embargo; some were from within the US using non-Cuban ingredients, though), found:
❝policosanol is more effective than plant sterols and stanols for LDL level reduction and more favorably alters the lipid profile, approaching antilipemic drug efficacy❞
Those last words there, to be clear, mean “yes, the original claim of being on a par with statins is at least more or less true”.
Source: Meta-Analysis of Natural Therapies for Hyperlipidemia: Plant Sterols and Stanols versus Policosanol
2018: also yes, the Cuban kind does get those extra-effective results, even when tested outside of Cuba
A Korean research team verified this; it’s quite straightforward so for brevity we’ll just drop links:
- Consumption of Cuban Policosanol Improves Blood Pressure and Lipid Profile via Enhancement of HDL Functionality in Healthy Women Subjects: Randomized, Double-Blinded, and Placebo-Controlled Study
- Long-Term Consumption of Cuban Policosanol Lowers Central and Brachial Blood Pressure and Improves Lipid Profile With Enhancement of Lipoprotein Properties in Healthy Korean Participants
Mystery resolved!
Want to try some?
We don’t sell it, but here for your convenience is an example product on Amazon—it’s not the Cuban kind, because the US’s trade embargo makes it difficult for the US to import even things that are theoretically now exempt from the embargo such as food and medicines. In principle they can now be imported, but in practice, the extra regulations added to Cuban imports make it nearly impossible, especially for small sellers.
Still, it’s 40mg/tablet policosanol from sugar cane extract, and 3rd party lab tested, so it’s the next best thing 😎
Enjoy!
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