Living With Chronic Pain

Bed Rest?

Decades ago, strict bed rest was the treatment for any acute back pain. I remember as my mother was admitted for ”strict adherence” to the recommended treatment for two days when she experienced acute pain. While it may have been a welcomed respite from five little kids at home, the literature is now clear- whether a new complaint or exacerbation of a chronic one, this is the worst thing you can do. 

It’s estimated at least 80% of people have experienced back pain in their lifetime. Over a third experience low back pain daily. It’s the third most common reason to visit a provider and half of all working adults report having back pain symptoms annually. It’s the number one reason for disability.

Yet many still hold onto antiquated treatments such as recommending extended bed rest for the initial concerns. Most injuries are caused by bending, lifting or twisting wrong. Do all three at once and the pain can be excruciating. But even just leaning to the floor to pick up a pencil or sitting too long can be enough to cause a spasm.

The back has a remarkable amount of muscles, all connected to tendons that then connect to the spinal vertebrae. It’s not hard to tweak one. And the lower spine attaches to the sacrum which attaches to the pelvic bones. Another common source of low back pain is when this intersection- the sacroiliac joints- get inflamed. And just like any other sprain or strain, it can take weeks to heal.

In one study, participants with an acute back pain were put into one of three groups. Bed rest for two days, back mobilizing exercises, or the continuation of normal routines as tolerated. They were assessed weekly for twelve weeks. Those kept at normal activity had statistically significant improvement in duration of pain, pain intensity, lumbar flexion, ability to work and no time lost from work. Recovery was the slowest in the bed rest group.

Lying in bed for a few days will actually worsen pain and cause it to last longer by allowing those tight, inflamed and spasmed muscles to stay that way. I’m not recommending you run a marathon or lift weights, but light activity such as walking and stretching to encourage those sore muscles to move and surge nutrients and oxygen into the injured areas will remove the inflammation and allow faster healing. 

If your pain is severe, just take a day in bed and mobilize every few hours to get the muscles moving. To ease the pressure on your back put a pillow under your head and between your knees if on your side. Under your bent knees if on your back. These positions will reduce the pressures normally on our back with sitting and standing.

While you may feel better with extended bed rest in the short term it isn’t helpful at any stage of recovery because it can trigger other issues:

* Muscles start to lose conditioning and tone. Research shows you lose 1% of muscle strength each day you stay in bed. Another study suggested muscle size can be decreased by 11% after ten days without exercise, even when not bed ridden. 

*Digestive concerns such as constipation. Exercise and movement are key to keeping the gastrointestinal tract running smoothly. Even a day or two in bed can cause digestive slowing that can lead to bloating and constipation.

* The intervertebral disc size increases because of increased absorption of fluids when we lie in bed. As a result, the risk of herniation is higher when we do any bending activities upon arising.

*Bed rest changes the normal lordotic curve (a reverse C shape) of the spine making it flatter, which then changes the way our spine adapts to lifting and movements. This can lead to a higher risk of injury.

*Bed rest can lead to poor circulation in the legs that allows for blood clots to develop, leading to deep vein thrombosis and/or pulmonary emboli.

*Prolonged bed rest can perpetuate the belief you’ll never be the same again, causing  us to feel dependent and depressed. I’ve seen healthy, well built young men and women after an injury at work scared to death it’ll “be permanent” and fearful to engage in even minimal activity. Encouraging them to get past this belief and understand they are actually exacerbating the pain can be a difficult concept to overcome.

Staying active, getting back to work and normal walking, sitting and standing, with rest periods as needed, will result in a faster resolution. Minimize lifting to no more than five pounds and move often. Ice acutely, then heat. This will stimulate oxygen and nutrients, remove inflammation and loosen spasms. Add massage and topicals before and/ or after and you’ll be ready to go.

Remember less than 0.2% of back injuries turn out to be a herniated disc. But if the pain persists or radiates into the legs, seek medical care to define if more aggressive intervention, e.g. medications, physical therapy, or evaluations, are warranted. 



https://www.health.harvard.edu/pain/bed-rest-for-back-pain-a-little-bit-will-do-you

https://pubmed.ncbi.nlm.nih.gov/19903317/

https://pubmed.ncbi.nlm.nih.gov/23550781/

https://www.nejm.org/doi/full/10.1056/nejm199502093320602

https://www.spine-health.com/blog/bed-rest-not-always-best-bet-beating-back-pain

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