When I first graduated from PT school over 16 years ago, bed rest was still a very popular treatment for acute back pain. Luckily, over the years, the medical community has taken a much more “active” approach” to treating back pain. However, there is still a small portion of the medical field that believes in bed rest for the management of back pain.
An interesting study published in Spine recently may have them thinking otherwise. German researchers wanted to know the effects of 60 days of bed rest on the discs of the spine and other soft tissues of the spine.
Their conclusions were not good for bed rest advocates:
- There was a loss of the normal lordosis usually seen in the lower back from L1-L3.
- There was an increase in the volume of the intervertebral discs as they imbibed fluid that leads to greater stress on the facet joints when you do finally stand up and ambulate. Ever wonder why you have more back pain in the morning? You now have a possible answer.
- All spinal muscles atrophied (lost strength) with the greatest rates occurring in the multifidus muscles at the L4-5 level. The multifidus has been identified as a major stabilizer of the lower lumbar spine.
We need to understand there are numerous other deleterious effects of bed rest, including vascular changes, bone loss, joint contractures, bed sores, breathing issues, the list goes on and on…….
One caveate to the study: it looked at individuals who were on bed rest for 60 days, not the typical length of time prescribed for individuals with back pain. However, other studies have shown similar results (to lesser degrees of course) even after 2-3 days of bed rest.
Take home message: take an active approach to the management of lower back pain and avoid much more than 1 day of bed rest if possible. Remember, Movement is Life!!