To Rest Or Not To Rest

I thought it was about time I threw some light on to a particular aspect of back pain. This particular aspect is the one regarding the prescription of rest.

We will begin with a delve back into history, not too long ago may I add but considered prehistoric to some, especially in terms of the methods of treatment for back pain.

The actual history of low back pain is another story but let's just revisit the recent past. The time I am referring to is when you visited your doctor complaining of back pain and the sum total of the medical help you received was being told to go home and lie on a board for six weeks. This people duly did and were compliant to varying degrees I am sure. Some I presume lasted for the whole forty two days to the hour whether or not their pain had gone or whether they were in sheer agony and others more than likely, lasted until the first piercings of boredom roused themselves before dispensing with the said board.

How long ago this practice died out is not easy to say. In fact I know at least one osteopath or chiropractitioner in The United Kingdom still utilises this course of action. This is for sure though now more the exception rather than the rule.

So was it or is it effective? To a degree yes. It allows the stresses of weight and movement to be taken off the injured spine so preventing further injury and enabling healing to begin with minimal disruption. The trouble is that unless the spine is fractured the benefits of lying down are essentially achieved in forty eight to seventy two hours. After this time the adoption of long periods of bed rest begins to have more negative than positive effects. These effects include joint stiffness, muscle wasting and other complications associated with long periods of immobility.

Other things to note are that advice was rarely if at all dispensed as to altering the lying posture to side or front (prone) lying for comfort or benefit.

As with so many things the pendulum tends to swing markedly to the other extreme once the seed of doubt has been planted into the consciousness of significant minds. Hence the new school of thought that came into being approximately twenty to thirty years ago was based on the hypotheses that 'rest was bad and movement was good.' So a trip to the doctors with low back pain yielded a "good dose of exercises and carry on at work, you'll be fine." Strangely enough this was not always successful as an antidote to the problem either.

Today the pendulum of medical opinion for me as a Chartered Physical Therapist with all the benefits of hindsight and experience has brought me to the point where I believe the best answer lies somewhere in between with a balance of CORRECTLY PRESCRIBED REST AND EXERCISE.

I generally find that with acute back pain, rest is needed to take the stress off the back structures to help the inflammation and pain to settle and allow healing to beginr. This rest is not strict bed rest but is more often than not prescription of lying down for a period of forty eight hours with changes of position allowed for, as well as breaks for trips to the bathroom and for eating and drinking encouraged periodically during the day. With the correct analgesia I find that this amount and specificity of rest achieves a state where the back pain is settled to a degree sufficient to allow movement and therapy to move the process on to the next level.

So rest is neither good nor bad. It is just a tool for us to use in our armory. Insufficent rest will see the exacerbation of inflammation and continuation of pain. Excessive rest will see an onset of joint stiffness, muscle weakness and functional disability amongst other possibilities.

The answer seems to lie (pardon the pun) with utilizing initial and short periods of rest of approximately forty eight hours to reduce the effects of acute inflammation and then use graded treatment and movement to return the spine to as healthy a state as possible. This can take variable amounts of time depending on the particular problem, the details of which are probably best left for another time.

So there we have it: to rest or not to rest, that is the question. You now have the answer.

Copyright 2006 Robert Ryles