Low Back Pain - Exercise or Bed Rest If you are one of the estimated 80% of the population who gets Low Back Pain (LBP) at some time, what should you do? Is it better to stay in bed for a day, a week or a month, or should you be exercising? Is a marathon too much and a walk around the block not enough. In the article that follows, I'll give some advice and let you know what the current research says on the subject. I'm sure some of the recommendations coming from recent research on exercise will surprise you.
Bed Rest - If pain is one of your body's ways of protecting itself, surely lying still in bed without provoking anything has to be good for you. If you agreed with that you'd be right - kind of. For the first couple of days, it's not bad advice for some people. In a study in 1995 from The British Journal of General Practice they stated, "48 hours' bed rest cannot be recommended for the treatment of acute low back pain". More recently the advice has become more specific. The European Guidelines for LBP advise that if the pain is so intense that bed rest is appropriate, the rest should be no more than a few days and should not be considered a treatment. US guidelines say that the majority of back pain patients will not require bed rest.
Bed rest beyond a few days has been shown to be worse for LBP sufferers than being active sooner. In 1996 a Finish study found that patients who had bed rest for a week had less flexibility and more sick days than those who continued their activities.
There are some explanations for this. The joints in the spine and our discs are designed for movement. The vertebral disc doesn't have arteries and veins. Movement is critical to keeping a disc healthy. If you avoid activity for long periods of time you start to lose muscle tone. The framework that provides strength to your back becomes weaker and you become even more prone to LBP.
Exercise - If you imagine that your back is like a big circus tent you can understand how important muscles are. If your spine was the big pole in the centre of the tent, how strong would the tent be if that's all there was. To make the circus tent much stronger, the tent is stretched out and held to the ground with pegs and ropes. In your back this is what your muscles do. Without muscles working well, the back is very weak, but with the help of back muscles, your back is able to lift very heavy objects and be put under a lot of stress. That is why the function of your back muscles is so important and why exercise for those muscles is critical.
In terms of the amount of exercise to do when you have back pain there are some different and almost contradictory advice. Up until recently, the overriding advice would have been to exercise but "let pain be your guide". The advice was that if you felt pain it was a sign that something wasn't right and you should stop. There is another approach that has recently been adopted that is almost the opposite philosophy. It is the idea that returning to normal activities as soon as possible is the most important thing. A very important medical group (The Cochrane review) stated "There is no evidence that advice to stay active is harmful for either acute LBP or sciatica". The idea is that it is that you don't want to get into a viscous cycle of reducing activities because of fear of pain and then your back becomes even worse, and then having to reduce your activities even more, and so on. The Occupational Health Guideline from England states "advice to continue ordinary activities of daily living as normally as possible despite the pain can give equivalent or faster symptomatic recovery".
There is still a large minority of GP's recommending bed rest for LBP however the recommendation is to avoid bed rest unless the pain is too severe. As far as exercise goes there are two opposing viewpoints. My personal experience is that a little bit of discomfort or mild pain isn't necessarily a bad thing if it is helping you to resolve your LBP. The obvious caveat is that you don't want to be doing activities that are harmful for your back. If this is different to what your health care provider recommends then discuss it with them before changing anything.