| Low back pain is one of the most common | | | | Over the years, studies have emerged showing |
| reasons for consulting a physician. Despite little | | | | that bed rest of any duration is not effective for |
| supporting scientific evidence, bed rest was | | | | low back pain and that it often delays recovery. |
| considered the primary treatment from the late | | | | In fact, other than delayed recovery, prolonged |
| 19th century. What has changed now is how back | | | | bed rest can also have detrimental effects on the |
| pain is understood and managed. | | | | body. Patients with prolonged bed rest may end |
| History of Back Pain and Rest | | | | up with osteoporosis (bone calcium loss), muscle |
| Rest was first proposed as a treatment by John | | | | wasting due to muscle protein loss, deep vein |
| Hunter (1728-1793), a Scottish surgeon, in his | | | | thrombosis and undesirable psychological effects. |
| study on wounds and inflammation. He believed | | | | Current Approach |
| that the first and most important requisite for | | | | So the question now is, if bed rest has been |
| restoration of inflamed, injured parts is rest, as | | | | shown to be detrimental and ineffective as |
| rest is necessary for repairing injured parts. This | | | | treatment, would early activity be better? |
| proposed idea of rest as a treatment was further | | | | Several studies have looked at the effects of |
| amplified by John Hilton (1804-1878), a British | | | | advice to stay active in the treatment of acute |
| surgeon, in his 1862 series of lectures on "Rest | | | | low back pain and found that advice to stay |
| and Pain" to the Royal College of Surgeons. He | | | | active was better or similar to advice to rest in |
| claimed that it is the natural treatment for the | | | | bed. In an update of a 2004 Cochrane Review of |
| inflammation of injury and wounds. | | | | trials on bed rest for acute low back pain and |
| Their theory of injury leading to an inflammatory | | | | sciatica, it was found that for patients with acute |
| response that requires rest to heal the body had | | | | pain, advice to rest in bed was less effective in |
| a huge influence throughout the field of medicine | | | | reducing pain and improving an individual's ability to |
| even though their works revolves around only on | | | | perform every day activities than advice to stay |
| inflammation and wounds. Physicians all over the | | | | active. For patients with sciatica, there was little |
| world started to use rest as a treatment for a | | | | or no difference between advice to rest in bed |
| wide range of conditions, from myocardial | | | | and advice to stay active. |
| infarction to normal childbirth. | | | | For chronic back pain sufferers, exercise therapy |
| Throughout the 19th century, the orthopedic | | | | has been supported by good evidence to reducing |
| principle of rest became dominant. The rationale | | | | time taken to return to work and improving |
| of rest for back pain started from the idea that | | | | functional status. Patients prescribed with graded |
| pain was due to injury. With injury, inflammation | | | | exercises have been shown to return to work |
| occurs and thus rest was essential for healing. If | | | | sooner, have less disability, and have fewer pain |
| the primary injury was not properly treated with | | | | complaints than patients treated with medications |
| rest, chronic pain would develop. It was believed | | | | and bed rest. |
| that movements, physical activities and repeated | | | | Conclusion |
| back injuries during the inflammatory phase may | | | | Given the extensive research done in recent |
| increase pain and so must be harmful, and thus | | | | years, there is rising evidence to point towards |
| should be avoided. | | | | avoidance of bed rest for the management of |
| This thinking was later applied in the treatment of | | | | back pain. Advice on early, progressive activity, |
| a ruptured disc, where the disc "comes out". The | | | | with no more than 2 days of bed rest, will serve |
| idea was that with bed rest, i.e. lying down, disc | | | | as the preferred current approach. |
| pressure is the lowest and the disc will somehow | | | | References |
| "go back". Unfortunately, there was no scientific | | | | |
| evidence back then to support bed rest as | | | | 1. Allan, David B. and Waddell, Gordon(1989). A |
| treatment. Orthopaedic doctors just followed with | | | | historical perspective on low back pain and |
| what was taught to them, i.e. bed rest. By 1900, | | | | disability',Acta Orthopaedica,60:3,1-23. |
| a standard orthopaedic text was published and | | | | 2. Deyo RA, Diehl AK, Rosenthal M. How many |
| recommended two to six weeks of bed rest for | | | | days of bed rest for acute low back pain? The |
| acute back pain. | | | | New England Journal of Medicine 1986; |
| Doubts Form in Approach | | | | 315:1064-1070. |
| Although some doctors during the 19th century | | | | 3. Gorden Waddell. The Back Pain Revolution. |
| did question the use of bed rest, it was not until | | | | Churchill Livingstone, New York. 1999. |
| the 1980s that its efficacy as a treatment for | | | | 4. Hagen KB, Hilde G, Jamtvedt G, Winnem M. Bed |
| back pain began to be seriously questioned. | | | | rest for acute low-back pain and sciatica. |
| However, many then still felt that some rest was | | | | Cochrane Database of Systematic Reviews 2004, |
| necessary, and initial studies only questioned the | | | | Issue 4. Art. No.: CD001254. DOI: 10.1002 |
| amount of rest that was needed rather than | | | | 14651858.CD001254.pub2. |
| whether it was needed at all. | | | | 5. Lindstrom I, Ohlund C, Eek C, et al. Mobility, |
| In 1986, Deyo et al were the first few to | | | | strength, and fitness after a graded activity |
| investigate the use of bed rest in low back pain. | | | | program for patients with subacute low back pain: |
| The study compared the functional status and | | | | a randomized prospective clinical study with a |
| symptoms of a group that received 7 days of | | | | behavioral therapy approach. Spine 1992; |
| bed rest with a second group that received 2 | | | | 17:641-652. |
| days of bed rest. No difference was found | | | | 6. Lindstrom I, Ohlund C, Eek C, et al. The effect |
| between the two groups in terms of the | | | | of graded activity on patients with subacute low |
| functional status and symptoms. This later formed | | | | back pain: a randomized prospective clinical study |
| the basis for several guidelines that advise no | | | | with an operant-conditioning behavorial approach. |
| more than 2 days of rest for patients with acute | | | | Physical Therapy 1992; 72:279-293. |
| low back pain. | | | | |