Introduction

Some experts recommend bed rest, and others exercise, to relieve the pain of acute low back ache due to sprains or strains, the most common form of acute low back pain. Which is best? A group of Finnish investigators have performed a neat research study to resolve this apparent contradiction, and have found that it's better to avoid bed rest during the first 2 days of this painful condition.

Methods

Three types of treatment were given randomly to employees of the city of Helsinki, Finland, who presented with acute low back pain or worsening of chronic pain lasting for less than 3 weeks. The first type of treatment consisted of 2 days of bed rest, and the second of light back mobilizing exercises; the third treatment type advised the avoidance of bed rest and mobilizing exercises completely, but continuation of normal activity to the extent permitted by pain intensity.

Those patients allocated to bed rest were told to take 2 days of complete bed rest, with only essential walking allowed. While lying in bed, the knees were to be supported by pillows in a slightly flexed position. Those patients allocated to the exercise group received individual training sessions with a physiotherapist, as well as written instructions showing back extension and lateral bending exercises. The movements had to be done 10 times in each direction, but performed carefully enough to avoid aggravation of pain. They had to be done every 2 hours during the day until the pain disappeared. Patients in the third group were told to avoid bed rest and to continue routine activities as much as their pain allowed. Note that patients in the first 2 groups were also told to resume normal activities once the bed rest period or the exercises were completed.

All the subjects were insured for absence from work due to illness. The measurements made after 12 weeks of follow-up were: the number of sick days, pain intensity and ability to work, a back-disability score (Owestry), a quality-of-life score, and satisfaction with treatment.

Results

A total of 186 subjects participated in the research: bed rest was prescribed to 67, exercise to 52 and normal activities as permitted by pain to 67 patients. Sixty percent of them were female. Their average age was 40.

By the time they started treatment, the average duration of pain was about 5 days, and the ability to work was reduced by approximately 50% (5-6 units on an 11-unit scale), in all 3 groups. After 3 and 12 weeks, the patients in the third group - those told to avoid bed rest and continue normal activities as much as possible - had the greatest improvement scores for duration of pain, intensity of pain, ability to work and number of days off work. For instance, the average number of days absent from work was only 4.7 in the third group compared to 7.2 days in the exercise group and 9.2 days in the bed rest group. Recovery was the slowest in those subjects who had complete bed rest for 2 days, while those on the back exercise program had intermediate results.

Recommendations

The authors conclude that workers with acute low back pain are better off if they avoid bed rest and maintain normal activities, as far as possible. This opinion is supported by other studies showing that bed rest slows recovery from pain and function in patients with acute (i.e. less than 3 weeks' duration) lumbar sprain. Of course, this conclusion is only valid for the most common form of low back pain known as a strain, sprain or 'vertebral facet syndrome' (due to osteoarthritis), as patients with severe underlying diseases - in particular those with nerve compression, fracture or urinary tract infection - were excluded from this study.

Provided your doctor thinks you just have a simple back strain or sprain, you are therefore well advised to 'carry on' (with the help of simple pain killers), rather than taking to your bed.