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BED REST, EXERCISE, OR NORMAL ACTIVITY FOR ACUTE LOW BACK PAIN?
The optimal approach to treating acute low back pain is quite controversial. This Finnish trial randomized 186 sufferers to either two days of bed rest, back-mobilizing exercises, or routine activity as tolerated (the control group). None of the patients had findings suggestive of sciatica, and the mean duration of pain before randomization was five days. Back-mobilizing exercises involved back extension and lateral bending every other hour while awake until the pain subsided. During three weeks of follow-up, patients in the control group missed significantly fewer days of work, on average, than patients treated with bed rest or exercise (4.1 missed days, vs. 7.5 and 5.7 days, respectively). Several other subjective and objective assessments of pain and function favored the control group at both 3 and 12 weeks. Comment: These findings are not surprising; it has long been my impression that most patients with acute low back pain improve in spite of, and not because of, our interventions. But it certainly remains possible that bed rest and exercise help some subgroups of patients not identified in this study.
— AS Brett
Published in Journal Watch General Medicine February 24, 1995
Citation(s):
Malmivaara A et al. The treatment of acute low back pain -- bed rest, exercises, or ordinary activity?. N Engl J Med 1995 Feb 9 332 351-355.
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