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Activity or Bed Rest For Low Back Pain?

Posted Oct 23 2009 10:04pm

Considerable evidence in the past decade shows that bed rest is not beneficial to patients suffering from low back pain (LBP). However, the clinical relevance of these findings has been questioned because previous research did not differentiate between different types of LBP. Some speculation has also been put forth that because the supine position minimizes intradiscal pressure, bed rest may have different effects on LBP patients with vs. without sciatica.

This review by the Cochrane Collaboration Back Review Group analyzed all randomized studies up to March 2003, yielding two new trials comparing advice to rest in bed with advice to stay active for patients with LBP. Two reviewers independently assessed methodologic quality and extracted relevant data from the trials. In total, six trials compared bed rest with staying active for the management of LBP.

Results:

  • Advice to rest in bed is clearly less effective than advice to stay active for patients with acute simple LBP. There is high-quality evidence for small but consistent differences in favor of staying active for pain and functional status at 3-4 weeks follow-up. And at 12 weeks follow-up.
  • For patients with sciatica, there is moderate-quality evidence that advice to rest in bed has little or no effect on pain and functional status compared to stay-active advice at 3-4 weeks and 12 weeks.
  • For patients with acute simple LBP, there is high-quality evidence that advice to rest in bed will increase length of sick leave in the first 12 weeks, compared to advice to stay active. For patients with sciatica, advice to rest in bed has little or no effect on the length of sick leave compared to advice to stay active (based on moderate-quality evidence).
  • For patients with confirmed nerve root involvement, there are few or no differences between advice to rest in bed and advice to stay active.

Reference: Hagen KB, Jamtvedt G, Hilde G, Winnem MF. The updated Cochrane Review of bed rest for low back pain and sciatica. Spine, March 1, 2005;30(5):542-46.

In other words… for simple cases of lower back pain, your best bet is to stay active, stretch it out, and don’t baby it too much. If it is more complicated or involves the nerve roots, chiropractic care is your first line of defense.

Considerable evidence in the past decade shows that bed rest is not beneficial to patients suffering from low back pain (LBP). However, the clinical relevance of these findings has been questioned because previous research did not differentiate between different types of LBP. Some speculation has also been put forth that because the supine position minimizes intradiscal pressure, bed rest may have different effects on LBP patients with vs. without sciatica.

This review by the Cochrane Collaboration Back Review Group analyzed all randomized studies up to March 2003, yielding two new trials comparing advice to rest in bed with advice to stay active for patients with LBP. Two reviewers independently assessed methodologic quality and extracted relevant data from the trials. In total, six trials compared bed rest with staying active for the management of LBP.

Results:

  • Advice to rest in bed is clearly less effective than advice to stay active for patients with acute simple LBP. There is high-quality evidence for small but consistent differences in favor of staying active for pain and functional status at 3-4 weeks follow-up. And at 12 weeks follow-up.
  • For patients with sciatica, there is moderate-quality evidence that advice to rest in bed has little or no effect on pain and functional status compared to stay-active advice at 3-4 weeks and 12 weeks.
  • For patients with acute simple LBP, there is high-quality evidence that advice to rest in bed will increase length of sick leave in the first 12 weeks, compared to advice to stay active. For patients with sciatica, advice to rest in bed has little or no effect on the length of sick leave compared to advice to stay active (based on moderate-quality evidence).
  • For patients with confirmed nerve root involvement, there are few or no differences between advice to rest in bed and advice to stay active.

Reference: Hagen KB, Jamtvedt G, Hilde G, Winnem MF. The updated Cochrane Review of bed rest for low back pain and sciatica. Spine, March 1, 2005;30(5):542-46.

In other words… for simple cases of lower back pain, your best bet is to stay active, stretch it out, and don’t baby it too much. If it is more complicated or involves the nerve roots, chiropractic care is your first line of defense.

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