Low Back Pain – Why bed rest does not help?

Acute low back pain is most common reasons for young adults to see a family doctor. About 80% of people have suffered at least once with low back pain during their lifetime. Although most of the patients recover quickly with minimal treatment, proper evaluation is imperative to identify rare cases of severe underlying pathology.

Factors that increase the risk

Factors that increase the risk of developing low back pain include smoking, obesity, physically strenuous work, a stressful job, sedentary work, job dissatisfaction and psychological factors such as anxiety or depression.

Certain warning signs should prompt aggressive treatment for a referral to a spine specialist whereas others are less concerning. Serious red flags include trauma (i.e., injury due to falling from a height or road traffic accident, or heavy weight lifting and bad posture, other bone disorders such as osteoporosis), progressive motor or sensory deficit, retention, bladder incontinence or urinary loss of anal sphincter tone.

When there are no clinical signs of severe pathology, diagnostic imaging and laboratory tests often are not needed. Although there are numerous treatments for acute back pain, most have little evidence of benefit. Medications such as non-steroidal anti-inflammatory drugs are beneficial, as is patient education.

Why bed rest is inadvisable?

Contrary to conventional belief, research indicates that bed rest should avoid if possible. Researchers from the Cochrane database conducted a study to examine whether Bed rest or any other activities best for recover from back pain in the short term. The summary, published in the Cochrane database found that staying active was better in improving function than bed rest.

“Patients who are active they experience less pain and also stay away from the side effects of immobility

Bed rest should not recommend for patients with acute low back pain. Moderate quality evidence suggests that bed rest is less efficient in reducing pain and improving function in 3 to 12 weeks that advice to stay active.

Prolonged bed rest can also cause side effects such as joint stiffness, muscle wasting, and loss of BMD (bone mineral density), pressure ulcers, and venous thromboembolism.

Classification of lower back pain

Lower Back pain can be classified in to two types:

  • acute (pain that lasts less than 6 weeks) or (6-12 weeks)
  • Chronic (more than 12 weeks)

Most people experience acute low back pain during their lifetime. The first episode usually occurs between 20 and 40 years. For many, low back pain is the first reason to seek medical attention as an adult. The pain can be acute to chronic and debilitating, causing anxiety.

Many cases get resolved with little intervention. However, 31 percent of people with low back pain do not recover completely within six months, although most are improved. Recurrent back pain occurs in 25-62 percent of patients within one to two years, with up to 33 percent with moderate pain and 15 percent having severe pain.

In most episodes of low back pain, a specific underlying cause has not identified the pain is due to mechanical problems such as muscle or joint stress. In most cases, imaging tools such as X-ray and CT (computed tomography) are not useful and carry their risks. However, the use of images in low back pain has increased.

Some times low back pain is caused by damaged IVD’s (intervertebral discs), and the test of straight leg raise is useful to identify the cause. In people with chronic pain, the pain processing system may malfunction, causing much pain in response to non-serious events.

Treatment of acute non-specific low back pain is typical with medical management such as the use of simple pain medications and continued normal activity such as pain allows. Medications recommended for the length to be useful, acetaminophen (also known as paracetamol) as the first drug of choice. Symptoms of back pain usually improve within a few weeks from the moment they begin.

For much of the 20th century, “rest”, which meant, in general, a few days to a week in bed – was the first prescription for the acute low back ache. In recent decades, however, physicians began advising patients to stay as active as they could.

Treatment of acute low back pain

It is important that the information and treatment are consistent across professions, and that all health care providers work closely together.

The treatment of acute back pain in primary care aims to:

  • Provide adequate information, reassurance that low back pain is usually not a serious illness and rapid recovery expected in most patients
  • To provide sufficient control of symptoms, if necessary
  • Refer the patient to remain as active as possible and return early to normal activities, including work.
  • A proactive approach is the best treatment option for acute low back pain.

Passive treatment modalities: (e.g., restrooms, massage, ultrasound, electrotherapy, laser, and traction) should be avoided as mono-therapy and should not routinely use, as they may increase the risk of disease behavior and chronicity.

Recommendations included in these guidelines refer mainly to pain caused activity limitations or for patients seeking care. Referral to secondary general health care should be limited to patients in whom there is suspicion of serious spinal pathology or nerve root pain.

Recommendations for treatment are included only if there is evidence of systematic reviews or high-quality RCTs (randomized clinical trials) in acute low back pain. ECA have identified in various interventions commonly used for acute low back pain; For example heat and cold therapy, electrotherapy, ultrasound, acupuncture, trigger point and the facet joint injections and physical therapy (exercises). 

Physical Therapy

Exercises directed by a physiotherapist, such as spine extensors strengthening, core stability may decrease the recurring pain. The pain can be intermittent or constant. In most cases, low back pain resolves on its own within a few weeks. The pain can have a slow onset or occur suddenly.

Patient Education

  • The patient should be aware of proper postural techniques and stay active as possible, within the limits of pain.
  • Prevent twisting and bending, especially when lifting; and to return to normal activities as soon as possible.
  • The aim is to reduce concerns about back pain and teach ways to avoid worsening pain or recurrence of pain.

Have a question?

Feel free to ask us for any help or information here!

Dr. Kaleem Mohammed graduated as a Bachelor of Physiotherapy in 2014 from Deccan College of Physiotherapy, affiliated to Dr. N.T.R. University of Health Sciences, Vijayawada, India. Dr. Kaleem is an expert at handling physiotherapy needs of patients suffering from orthopedic and spinal conditions and post-surgery rehabilitation. Dr. Kaleem is associated with HealthClues since its inception where he facilitates diagnosis and advanced consultation with senior doctors. He is also a medical researcher and prolific writer who loves sharing insightful commentaries and useful tips to educate the patient community about fitness, treatment options, and post-treatment recovery.

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