It’s the old advice that we may have grown up listening to, or heard from health practitioners over the years when you’ve hurt your back: “Lie down for 3-7 days with minimal movement and avoid all activity to allow your body to heal”. But is bed rest really a good idea for acute low back pain?
In a simple answer: No.
In fact, a 2018 overview of 12 clinical practice guidelines for low back pain found 11 guidelines (92%) recommended avoiding bed rest for back pain altogether.
If that’s all that you take out of this blog then my job is done.
But for those that are a little bit more curious as to WHY bed rest isn’t a good idea, let’s explore the mechanism of movement and the “Do’s and Don’t’s”.
MECHANISM OF MOVEMENT FOR PAIN
Muscles were designed to contract. Therefore, they LOVE to move. This is one of the reasons why your Osteo is always nagging you to exercise!
When an injury occurs to the low back, whether that be an injury to the disc, facet joint or another structure, the muscles around that region will tighten and spasm. This is a protective function – the brain perceives a threat to the body’s structure, and thus acts to limit the amount of damage occurring.
While this protective function is important in ensuring the damage is limited, often the muscles contract and tighten so strongly that it severely restricts movement and can even cause more pain.
As stated above, you may be used to the advice of bed rest after an acute low back injury. Don’t get me wrong – rest is a very important part of rehabilitation and I am not advocating for you to push through the pain and continue living your normal life in the first few days following an injury. However, I AM advocating that you continue to move within this period.
Stopping movement altogether and sitting on the couch for 3 days will only make your muscles tighten and contract further, which will likely aggravate your pain.
There is further physiological reasons as to why moving is a good idea. Your muscles and other soft tissues rely on blood flow to heal and function. If we lie in bed or on the couch, our heart rate decreases and we diminish the body’s ability to deliver nutrients and oxygen to the tissues. Movement also allows for greater fluid exchange around the spine, helping reduce swelling and prevent inflammation. If we are able to reduce these factors we can recover much faster.
WHAT IS ‘GOOD MOVEMENT’?
Let’s get to the HOW of movement, because it’s important to set some parameters. Here are the DO’s and DON’T’s of movement in the early stage (1-7 days) of an injury:
✓ Find ranges of motion in the low back which are pain free and continue to move through this range. This might be bending side to side, forward or back. It doesn’t have to be a big range of motion!
✓ Add small walks in to your day. A 5-10 minute walk around the block is perfect as long as it’s not aggravating your pain.
✓ Wear supportive footwear when you are walking.
✓ Normal everyday activities can continue if they are not causing too much pain.
✕ Avoid exercises that flare up your back pain. This might include running, vigorous body strength exercise, and end of range movements.
✕ Avoid lying down/sitting down for long periods of time where possible. We recommend getting up at least every 30-45 minutes and moving your body, even if this just means a lap of the house!
If you stick with the above tips as part of your recovery following back injury you are much more likely to recover faster. As always, it is still important to get assessed by a qualified health practitioner to determine the extent of the injury – particularly if your pain is increasing!
Dr. Dan East (Osteopath) – Total Balance Healthcare
DISCLAIMER: THIS BLOG POST IS AN EDUCATIONAL TOOL ONLY. IT IS NOT A REPLACEMENT FOR MEDICAL ADVICE FROM A REGISTERED AND QUALIFIED DOCTOR OR HEALTH PROFESSIONAL.
