Why does my lower back hurt when walking?

Estimated reading time: 8 minutesThe current advice to to manage low back pain is to stay active (1), but what if walking – one of the most easy and accessible ways to stay active – results in pain?

We’ve explored chronic pain a great deal in my blogs. Dr Leslie Russek has shared her knowledge on pain mechanisms in hypermobility disorders, and I’ve examined chronic pain itself.

But there is an aspect we haven’t explored, and it is something my clients describe frequently. That is pain when walking. Typically, clients report their pain getting worse when they are walking slowly, like window shopping or visiting museums, for example.

I’ve also heard reports of how the pain increases the more people walk. Clients often have a time limit in mind – they know they can walk without pain for ten minutes, but then the pain starts increasing to the point where they have to sit down and rest.

We will explore research into lower back pain and walking, but there is very little research about why walking can create pain for some people, especially the hypermobile population, so this is very much my clinical experience and hypothesis.

Chronic or persistent lower back pain has been increasing in the past decades, and it is estimated that almost 20% of people between the ages of 20 and 59 experience it globally. This increases to 25% in older people (1, 2). In fact, it has been called the leading cause of disability worldwide (3)!

I trained in low back pain management in 2009 and became a back care specialist through my pilates training. I ran mat classes for clients suffering from lower back pain for many years. The classes were always full because back pain is such a major issue these days. Over my many years of clinical experience, I have worked with clients 1:1 on helping them manage and resolve their back pain. Movement is a great way to start working on this.

I created Moovlite to help people manage lower back pain. Moovlite is different than The Zebra Club because it doesn’t have the hypermobility watch points I use when working with the hEDS/HSD population. It is great if you have chronic back pain and want to address it with movement therapy.

Common causes of lower back pain when walking

Clinical pathologies could contribute to low back pain when walking, and it’s always good to get it checked out by your care team – especially if it’s new or profound.

• Lumbar spinal stenosis – pain that with walking or prolonged standing that radiates down one or both legs and is relieved by lumbar flexion (3)
• Herniated discs
• Facet joint dysfunction
• SI joint dysfunction
• Osteo arthritis
• Sciatica
• Muscle weakness in the lower back or hips may struggle to support the spine when walking, leading to pain with prolonged walking.

Lower Back pain in Hypermobility

There is some literature on hypermobility that I think may relate to why we have lower back pain when walking.

Increased movement in the joints:

One study from 2012 explored gait patterns in 17 hypermobile participants (4). They were exploring how pain impacts gait patterns. They concluded that the adults studied had higher levels of joint movements at the knee and hip joints than healthy subjects during walking in both the forward backwards and side to side movements. These increased movements resulted in higher bone-on-bone forces going through the joint, which could lead to pain.

Body awareness may be improved with tape:

A case study described a female EDS patient whose main symptoms were pain during walking (5).  She could only walk for a few minutes without pain in her lower back and knees.  The researchers applied neuromuscular taping techniques over the lower back and knees, studied joint movements before and after applying the tape, and monitored her for two weeks.

They found that walking patterns improved, including step length, speed, and rhythm. They refer to research that suggests that taping seems to stimulate cutaneous mechanoreceptors, resulting in physiological changes in the area that has been taped. They improved her body awareness through the tape.

Altered gait patterns:

One research group discovered that hypermobile patients tended to adopt a stiffening pattern in gait and that they walked slowly compared to the control group (6). Their hypermobility was not apparent during gait. They hypothesized that the stiffening of the tissues when walking could be an attempt to reduce pain and improve balance.

Finally, Robbins et al. also found altered gait patterns in hypermobile participants. Alterations in muscle activation and timing and spacing of steps during walking were observed in their study, and they concluded that this may be a result of impaired proprioception and balance and muscle weakness.

So, whilst the research is scarce on lower back pain and walking in the hypermobile population, we can already see that there are issues that could be contributing to painful walking.

How posture affects lower back pain while walking

Posture could be playing a significant role in low back pain when walking because our posture will impact the alignment of the pelvis, spine, and lower limbs and feet.  I always stress that alignment is key – when the bones and muscles are in a better alignment, the muscles, joints, and ligaments can work more efficiently with less strain.

If they have to work harder due to poor posture, this could lead to pain and discomfort. I say could because it is very individual – many people might have what is considered a ‘poor’ posture but experience no pain.

In one meta-analysis that analyzed 97 studies on walking and lower back pain, individuals with a history of persistent lower back pain had different biomechanics compared to back-healthy controls. This included a lack of coordination between the thorax and pelvis and differences in the activation of the paraspinal muscles. It was not clear if these differences are protective strategies in response to pain or compensation for muscle weakness or altered proprioception (8).

I always assess my clients’ feet – the alignment, the gait, the stride length and I examine what is going on further up the chain from the feet when walking.  As Gary Ward says, “when the foot hits the ground, a whole body chain reaction occurs”. We want that reaction to be fluid and pass through all the joints smoothly. But with an altered posture, that may not happen as easily as it could, which puts more strain on the joints – including the lumbar spine.

I think a big contributor could also be the forward head posture. This pulls not only the weight of the head forward but also the shoulders, causing a rounding of the upper back.  Again, this is going to impact walking efficiency and could put extra strain on the lower back.

Walking-related injuries and their impact on your lower back

Walking is generally beneficial for health and muscle tone, but injuries can happen that could contribute to lower back pain.

• A muscle strain or sprain – overexertion without preparation, poor gait mechanics, or sudden movements could lead to pain or stiffness.
• Sciatica can often come on with walking due to irritation of the sciatic nerve. This can cause sharp, shooting pains down the legs.
• Foot injuries and conditions like plantar fasciitis will impact the lower back as the gait changes. Ensure proper walking footwear with ankle support and cushioning to avoid impacting the lower back.

Is walking good or bad for back pain relief?

Walking is great exercise; it can improve blood pressure, cholesterol, and is great for the heart (1). One meta-analysis found it can help with pain or disability but is not superior to other exercises (9). For chronic lower back pain, exercise is the first line treatment recommended (10).

However, if walking is hurting, we may have to address some things first.

Gait mechanics can greatly contribute to pain in walking. This is why I always examine my client’s gait when we have our initial assessment. We’ve learnt from research that people with and without hypermobility may have altered gait patterns.

Hypermobile joints in the hips, low back, knees, ankles, and feet could be a cause. These hypermobile joints, if not controlled and stabilized, could lead to inefficient gait patterns and excess movements.  Remember, the body always takes the path of least resistance.

Photo by Katie McBroom on Unsplash

Tips to relieve lower back pain when walking

• Have a movement therapist, physical therapist, or physio look at your walking pattern, especially if you are planning a long trip that is going to involve a lot of walking that you are not used to. I’m all for prevention – let’s examine what’s going on before we embark on increased walking. It can sometimes be a simple mechanical fix to avoid increased lower back pain. Check out my interview with Gary Ward on my Finding Your Range podcast for an in-depth discussion about walking and pain.
• Overall postural tone and awareness training – we need to prepare the body for walking. If we have been sedentary due to illness, lack of mobility, or pain, we need to gently prepare the tissues with proprioceptive and stability exercises.
• Gradual progression – increase it gradually. You would never run a marathon without proper training.  We need to treat walking in the same way.   Use useful landmarks like from park bench to park bench or lamppost to lamppost. It’s a great way as you have a visual marker of your improved strength and ability.
• Appropriate exercises to build stability and strength.
• Correct, supportive footwear can do wonders for lower back pain. Maybe see a podiatrist for advice on the best ones for your feet.
• Start out walking on even surfaces as opposed to uneven terrain like rocky surfaces or the beach.
• Listen to your body – it’s OK to start with very small walks, and it’s OK to stop and rest when you need to.

How to strengthen your lower back for better walking support

This is going to be an essential part of reducing low back pain when walking – we need to tone, stabilize, and strengthen the muscles of the back, hips, pelvis, legs, and feet.  One thing the limited research into walking pain can inform us is that there are mechanical changes in walking.

It draws us to the fact that control of the joints is important – some participants had too much force going through certain joints, which led to pain. Proprioceptive awareness is part of this. If I am not aware of what my body is doing when I walk, I will not be able to make the necessary changes. If there is a lack of control in the gait cycle, the wrong muscles start trying to stabilize, and this could cause increased pain.

I’m instinctively drawn to my Integral Movement Method (IMM) – breath and relaxation to calm the heightened tone and guarding of the muscles, followed by proprioception and stability exercises. Leading up to balance and posture.  I would not work on a client’s painful walking by getting them to do more walking. We have to reverse engineer the process.

Exercises to start building strength and mobility could include

• Bridge
• Table Top
• CAT
• Pelvic Tilts

Stretches to reduce back pain after walking

It is a good idea to introduce some gentle dynamic movements after walking, especially if you experience stiffness or pain in the lower back. Here are some of my favorites:

• Hugging knees to chest – lying supine and drawing the knees into the chest. Breathe into the low back and allow the exhale to soften the tissues
• CAT – a beautiful dynamic stretch for the whole spine. You can also do this with hands on a chair or seated forward flexion if you don’t like weight-bearing.
• Child’s pose – if your knees can tolerate it, a lovely relaxing position to open up the lumbar spine.
• Pelvic tilts – gentle rocking of the pelvis forward and back and side to side to mobilize the tissues of the lower back.

FAQ

Why does my lower back hurt when walking?

It could be due to a number of factors like poor control of the body in the gait cycle leading to too much force going through the low back. Or overall low muscle tone, meaning muscles have to work much harder to move the body. It could even be unsuitable footwear and ankle support.

How do I stop my back from hurting when I walk?

We need to prepare the tissues for walking. Walking is great exercise, but it is a whole-body movement.  Work on building support and stability on the mat first so that walking becomes less painful.

Should you walk if you hurt your lower back?

If you have an acute injury in the lower back, it is always best to get this checked by a health professional first before embarking on walking as an exercise.  If you have chronic low back pain, walking can be beneficial for managing the pain.

Jeannie Di Bon

Jeannie Di Bon is a movement therapist, educator and author specializing in hypermobility, Ehlers-Danlos Syndrome and chronic pain. She is the founder of The Zebra Club app and the creator of the Integral Movement Method.