Bed Rest may be bad for back pain

Written by:  Richard Hansen, January 2009

            Acute low back pain continues to be one of the most common reasons why patients visit their primary care physicians.  Traditionally, bed rest and the use of pain medications have been the most common prescribed methods of treatment.  The thought with this approach assumed that bed rest would allow injured tissues time to recover without risking further injury from over-activity.  However, studies have shown that prolonged bed rest following an acute injury can actually lengthen the amount of time that it takes for the injury to heal than it would have if normal activity was continued.  In a study by Malmivaara et al, city workers in Helsinki, Finland who presented to an occupational health center with acute, nonspecific low back pain were evaluated in one of three groups (bed rest, back mobilization exercises, or normal activities).  The results of this study showed that patients with acute low back pain fared better and recovered faster when continuing their normal activities within their pain-free limits of motion than those that were prescribed at least 2 days of bed rest.  The reason for this is a physiological change that occurs in the spinal discs.  Bed rest causes a reduction in the load applied below the osmotic pressure of the disc.  This causes fluid to rush into the disc making it swollen and increasing the length of the spine resulting in an abnormal amount of pressure than is normal, causing “backache”.  These changes are noticeable even at 8 hours of bed rest, a normal night’s sleep.  The moral of the story is that lying in bed for longer than 8 hours actually stresses the spine.   This normal stress effect is increased even more if someone has an acute back injury.  It is therefore best and should be recommended that those who experience an acute back injury, depending on its severity, try to maintain a certain normal level of activity within moderation and without heavy lifting until the injury has resolved.

References: 
Malmivaara, Angie, et. Al.  “The Treatment of acute low back pain: bed rest, exercises, or normal activity?”.  New England Journal of Medicine. 1995;332:351-355.
McGill, Stuart. (2002) Low Back Disorders.  Champagne, Il. Human Kinetics