Bed rest and low back pain: potentially doing more harm than good.

It is completely natural to think that the best thing that you can do when you incur a low back injury is to rest. The thinking being that there has just been an injury to the muscles/ ligaments, and we need to give them time to heal. That was the leading recommendation for many decades, but current research is not only showing that it may not be the best course of treatment, it could actually be making things worse.

The muscles and joints in your low back are no different than the muscles and joints of any other part of your body. While the overall complexity of the structures of the back is higher, the healing response is the same. Most muscles and joints heal in similar manners, with the most current evidence is pointing towards giving soft tissue injuries, including those in your back, PEACE and LOVE.

The biggest change in what we used to think about the best way to heal soft tissue injuries and the updated view point is the emphasis on staying active. In the first few days after injury, there is nothing wrong with taking it a little bit easy and letting everything calm down. However, that does not mean that you should be doing no activity at all. You should continue to do your activities of daily living as long as they are not significantly increasing your pain. We tend to tell patients in clinic that they can do any activity that doesn’t increase their pain level more than 2 points on a 1-10 scale, and once they finish the activity the pain should slowly decrease down to the pre-activity levels over the course of 12-24 hours. Staying active will both help in the healing response and also prevent the injured tissues from developing an exaggerated sensitivity to movement. Muscles and joints, even injured ones, like movement and activity. Obviously too much activity too soon can re-injure the tissues, but no activity at all will lead to tissues that take longer to heal, feel stiff and weak once healed, and may lead to development of movement sensitivities long after the tissue healing has occurred.

Another concept that is helpful to understand when talking about low back injuries is that pain is not a good measure of tissue damage. We will continue to re-visit this in future posts but it has been shown many times in research that the level of pain someone is experiencing does not correlate to the amount of tissue damage. The best example of this is just how much a paper cut can hurt, but you can randomly wake up with a giant bruise and not remember how it got there. There is significantly less tissue damage occurring in a paper cut, but the level of pain would suggest otherwise. After injury, your back is naturally going to try and protect itself by giving you pain signals and stiff muscles and it is your job to convince your back that everything is ok. Slowly reintroduce movement and activity to show it that while there may be some pain tissue damage, there are still lots of activities that you are capable of doing without causing further damage. Your body is made to heal, and your back is strong and robust. Start with simple activities such as walking, light housework and other physical activity that doesn’t have high demands on your back. Once you start to feel better, keep increasing the demand on your spine by introducing range of motion exercises, stretching, and light lifting. As your back keeps getting stronger, keep increasing the demands you put on it. Before you know it, your back will be as good as new and ready to take on the world again.