Bed Rest Is Not Better For Your Bad Back

 istockphoto

Back pain is among the most common medical conditions that causes people to seek the evaluation of physicians. In fact, behind upper respiratory infections, back pain is the most common reason for a doctor's appointment in the United States. Just about every adult will experience an episode of back pain at some point in her life, and for many people, these can be frustrating and recurring problems.

On a positive note, the vast majority of people with back pain will find relief, and it is actually the relatively unusual situation where symptoms progress and become persistent. For most people, even when the pain is severe, the episodes tend to resolve spontaneously. Typical low back pain resolves within 6-12 weeks from the onset of symptoms, and often much more quickly. That said, having to go through an episode of back pain can be a frightening, and painful experience. Many people are convinced that something more serious is wrong, as they have not experienced that level of discomfort with other medical ailments.

Treatment of low back pain has evolved over the last decade. One of the most common treatments for many years was bed rest. When a physician would evaluate somebody with back pain, it was almost a universal recommendation that doctors told their patient to lie down in bed, and tried to limit their activity as much as possible, for at least 48 hours.

This treatment of so-called "bed rest" was thought to allow the acute inflammation associated with back pain to settle down to a level where people could then gradually increase their mobility and activity. After this initial period of bed rest, a gradual progression of activity was permitted. However, this advice is a thing of the past.

Nowadays, physicians recommend that you should get up and get moving as soon as possible after the onset of an episode of acute low back pain.

Why Was Bed Rest Recommended?

When someone has an episode of low back pain, finding relief of symptoms can be difficult. It is possible that by lying very still, and trying not to change position, that you can position yourself such that the pain may be relieved. Doctors thought that by allowing the pain level to subside, and inflammation to diminish, that a short course of bed rest could give you a jump-start on the healing process, and allow you to get back to activity more quickly.

To be fair to the clinicians of years past, this was a widely accepted recommendation, and the advice given was not to rest in bed indefinitely. The advice was simply to rest in bed for a period of a few days.  During this time, most physicians would advise patients to take anti-inflammatory medications to alleviate symptoms of discomfort, try ice or heat application, and allowed the most acute symptoms to settle down.

Weakness, Stiffness, and Atrophy

The fact is, decreased activity can actually cause more problems, even when limited to just a few days. Specifically, people who lie in bed and do not move actually develop weakness and atrophy of the muscles, and can develop stiffness with movements.

While the development of atrophy is a slow process, it can lead to a significant decline in function, and create an even more difficult problem as you try to recover.

Muscle strength can decrease by about 1-2 percent per day, and up to 20 percent per week, by lying in bed and not moving. People who have extended times at bed rest generally need very long periods of physical therapy in order to regain strength and mobility. In addition, there is a concern that treatment following bed rest may be more expensive because of the added therapeutic activity necessary to correct this loss of muscle strength and mobility.

Faster Recovery With Movement

The fact is, people who perform gentle activities, and light movements after lumbar spine injuries, actually recover faster, and their pain relief tends to occur more quickly when compared to those people who remain on bed rest. Current recommendations advise people with acute low back pain to perform gentle daily activities. Certain activities should be avoided, but that does not mean that complete bed rest is necessary. Some of the activities that should be avoided include:

  • Lifting anything heavier than a few pounds
  • Any pushing or pulling
  • Repetitive activities
  • Any specific movements that cause significant discomfort

There are some unusual causes of back pain where people may benefit from a short time of immobilization. Generally, these are limited to unstable fractures that occur after traumatic injuries. For treatment of typical acute or subacute low back pain (meaning an abrupt onset of symptoms in the early stages of treatment) medical experts a degree that activity is beneficial to accelerate recovery.

There are many different activities that you can perform that will help to maintain mobility and strength without putting too much strain on the spine.  Some of these activities might include:

It is also reasonable just to perform your normal daily activities including walking, showering, and moving around inside and out of the house. Avoiding bed rest does not necessarily mean actively exercising, but it does not mean that you were moving around such that stiffness and weakness do not develop.

A Word From Verywell

Despite the fact that, historically, bed rest was a common treatment recommendation when people developed acute low back pain, medical experts have come to the consensus that gentle activity is a better treatment for managing acute low back pain. By getting people to do gentle activities, stretching, and movement, recovery tends to be faster and easier. Complications of bed rest can be avoided by simply performing some light exercise and stretching activities. This will help to limit problems such as weakness and stiffness, and ultimately will get you back to feeling normal as quickly as possible.

Sources:

Choosing Wisely "Low Back Pain: How much bed rest is too much?" © 2014 Consumer Reports.

Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database Syst Rev. 2010 Jun 16;(6):CD007612.