Back Pain Relief: What About Bed Rest As A Back Pain Relief Strategy?
December 18, 2007 · Print This Article
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"Health care practitioners that prescribe bed rest as a back pain relief strategy are idiots.
Yes, you read right… they’re idiots.
Look… physical activity is an important part of the functional restoration approach in rehabilitation medicine. A patient’s natural tendency, however, is to avoid any activity that reproduces symptoms. Although it is important to protect an injured tissue from further injury, complete bed rest to relieve back pain IS NOT the solution.
Yet, even today, some health care providers prescribe bed rest and inactivity as a first line defense against back pain. And the effects? Disastrous to say the least.
It has been proven, well beyond reasonable doubt, that bed rest or inactivity is not only a bad option in the treatment of back pain, but that it also aggravates many other medical conditions.
Complete bed rest is…
“a highly non physiologic and definitely a hazardous form of therapy, to be ordered only for specific indications and discontinued as early as possible.”
That was the conclusion of an article published in 1944 in the Journal of the American Medical Association. Nevertheless, bed rest is, in many cases, the treatment method of choice for lower back pain.
But, compelling new evidence has created a complete shift in philosophy from an inactivity approach to an active approach in the treatment of back pain. Now, based on undisputable scientific evidence, it is widely recognized that rest and traditional physical therapy, in which patients receive passive treatment (such as ultrasound, heat, massage, etc.), are not very effective in the treatment of acute or chronic back pain.
Physical inactivity has several harmful effects:
- • Muscles, ligaments and bones weaken
• The spine stiffens and loses control and coordination
• Overall physical fitness deteriorates
• Patients become prone to depression and sensitive to pain
• Resumption of normal activities and daily routines become more and more difficult as time passes.
The current consensus is that inactivity is exactly the WRONG response to acute as well as chronic back pain. In patients experiencing acute back pain, my advice is for them to continue daily activities as much as possible. In chronic back pain cases, physical exercise can bring about some pain relief gradually, and the best results are obtained when a carefully designed functional restoration approach is followed.
The Erase Your Back Pain program utilizes the functional restoration approach in the treatment of the many conditions affecting the back. Find out all about this program here ⇒ No More Back Pain!
I welcome your questions and comments. Let me know what you think below.
Dedicated to Erasing Your Back Pain,
Malton A. Schexneider, PT, MMSc
Clinical Specialist
Orthopaedic Physical Therapist
Mr Schexneider,
In an earlier post you said that asking questions is very important and I agree,this is a little difficult for me being an English speaker living in Spain.
I will keep my history brief. In 2001 I was diagnosed with “Two level disc degeneration with an L4/5 posterior focal disc prolapse” I am 44 years old and since 2001 I spend somewhere in the region of three months per year unable to funtion normaly i.e. I go to hospital on a stretcher they feed me intraveinous drugs to kill the pain then i will spend another month on the floor crawling to the bathroom. Taking Adolonta liquid and Diazepan when neccasary. Then a further 2 months slowly improving.
However I manage one way or another to get to the Chiropracter even in a wheelchair one year, i find the chiro helps but slowly.
The docs say i need an opp but will not do it until i say I can take no more pain.I dont want an op!
I think it is easy to say bed rest is no good but often its my only choice. I have friends with the same problem who find walking is their relief,but when i am in my accute stage i can not.
I am not overweight , i eat healthely and the months i am well i go to the gym 4 times per week.( I always do my back stretches every day)
This year it has now been 7 months with no relief, I take my painkillers, go to work ( if i can ) and when i come back i am straight on the bed in agony.
I am concerned i cant even walk around the shops with my wife.
So it does anoy me when people say almost as you have ” get up and get on with it ” !
So what do you suggest ? I dont mind buying your book but i am a bit fed up with the same old ” do these exercises, eat well, swim take a massage lose weight ”
I already do these things but I have a medically diagnosed (MRI) problem that will never go away ( in my non doctor opinion )
Question : Should i consider an operation ?
Is your system anything that I havn;t already mentioned ?
What is my way forward ?
Thank you for listening ( no one wants to hear about my back and i hate talking about it.
Tony
Tony,
Man, I really empathize with you. Sounds like life really sucks right now (that’s a clinical term, by the way).
Anyway, here’s the deal: There are 4 reasons why you would consider surgery.
1. You have intractable pain that interferes with your function.
2. You have failed all conservative measures.
3. You have frank neurological changes.
4. Medical emergency.- tumor, cord signs, etc.
From your description, you make a good arguement for satisfying at least 2 of the 4.
The MRI findings don’t necessarily concern me as 85% of people waling around with no pain have similar findings.
Should you have surgery? I would first consider epidural injections (you didn’t mention those). See my article on epidurals here: http://tinyurl.com/5dbgfe
Will my program work for you? Possibly. And if it doesn’t, at the very least, you’ll be a better surgical candidate. And if it does…
Well I anticipate you’ll be running with the bulls really soon.
Let me know if I can help.
Dear Sir: I have read all of your topics and lessons on line. My problem is that my son had a work related back injury in 2005 and so far has had 12 PT treatments on August 2006 to Oct. 2006. ever since then, the medical care facility have not given him anykind of treatments for the reason that the insurance carrier had denied further treatmentsdue to the fact that the medical records do not indicate a need for referal to other services. Since that time til present, my son has been taking Vicodin continuosly til present with no other type of treatment. In November 2007, the insurance carrier with approval of the State Workers compensation Division sent him to an independant examiner who says that his injury had reached MMI (maximum Medical Improvement and that no future treatmen will be of benefit so the insurance carrier under WC laws is not liable for furhte treatment. However, due to the continuous pain, MY son refuses to do any bending in fear that the ppain will come back, and due to this inactivity, other muscles have tightened up and he is now worse of that the original injury. I would like to discuss this with you and see if you can help, but slpace is limited. can I write you in a lengthuy letter and give you all the facts to get your opinion, and suggestions on what kaind of help he can get. Right now, I’ve taken him to an Osteopath, Massage therapist, Pressure Point therapist, Physiatrist,acupuncturist, Chiropractor,and occupational therapist of a different nature, and they all agree that his condition now may not have been caused by the injury, but is in fact a result of not having the properdiagnosis and treatment that could have damaged other muscles by doing improper stretches and exercises. So now that the medical insurance carrier is of thehook, I must pay for all treatment out of pocket, and I definitly do not have the money because I was told that there are soo many problems as the result of delay in treatment thsayt it will take at least 2 years of hard work and a coordibnated effeort of 3 specialist to bring him back to normal. Have you had anything similar to this happen to someone you know? Thanx Curt
I’ve just read your article from Tony. I can buy your book, no problem, but like Tony I cannot walk sometimes. I just walk because I have too. For the past week I have being on pain killers and with it I drink a can of coke.The nurse at work says that the caffine from the coke will help the pain to go a little faster. At first it did, but not again. I take 3 -500 gm plus 2 - 220 gm of anaprox to come to work. I walk most of the day, except for about two hrs at the computer, where I do my orders. I had to cut my working hrs, because of the pain. I’m welcome to any suggestions.
Thanks
Annie
I really need more information. Go to http://eraseyourbackpain.com/forms.html and provide me the necessary information.
Thanks
Annie, your walking may be the problem. You irritate you sciatic nerve by walking. If there is an EMG proven nerve damage in your leg you might want to talk to your nurce at work regarding alternative work arangment.
Tony, Before surgery, look at every other option. I had a Percutaneous disection. That was 18 years ago. I’m still walking, still upright. Still active though L2-L3 thru L5-S1 have been chronic and deteriorating. I’m lucky, Malton IS my PT and has been for years. He regularly has to get my sacrum unstuck. I can sympathize with you as I’ve had to crawl to the pot many times. I now keep a portable one by the bed. I encouraging you to stay as active as you can. It does get better if you keep the hamstring, quads, and periformis stretched as much as possible. good luck and wish you good health. jim
I have spoken with you before. I have had the 3rd MRI come back witht he same results, a herniated disc…L5-S1
I have tried chiroprator, tens, rack, medications even nerve blockers, accupuncture. I am waiting to see a neuro surgeon. Workers Compensation has sent me back to work and for physio until I get an appointment with a neuro surgeon. Today was my first day at physio. The first thing she put me on was a bike for 20 minutes. I told her that I was in a lot of pain and that I have a saddle bum. She then took me to a chair and had me use two things to get more muscle in the lower leg. I am in a lot of pain tonight. I am to go back on Friday and she said that I will be working out for 1 1/2 hours. my first question is …is the bike a good thing to start off with especially with no warm up exercises or anything. I am back at work on a graduated return to work. WCB has restrictions on what I can and cannot do at work. I am to sit for 1/2 and hour then stand with a desk that rises for 1/2 hour to do my computer work. I find it strange that with all the restrictions that I have at work that the phyio would have me ride a bike for 20 minutes or I should say try to have me ride a bike. I could not and when she came back after 7 minutes…I told her that it hurt and she adjusted the seat but I still had pain and especially the saddle seat feeling. Tonight I am in so much pain. I am afraid to go back. I suggested that maybe what I should do is walk on the walking treadle and she said that will come later. My question is …is this the best way to start off physio…no warm ups right on to a bike when sitting is so hard on my back and legs…??
THANK YOU
Lillian