Acute Back Pain: Bed Rest or Movement?

Acute bouts of lower back pain will affect many over time. These moments can be prompted by faulty body mechanics, prolonged postures, and normal wear of the spine over time. Managing bouts of pain can be a challenging topic to broach. Bed rest and pain and/or muscle relaxant medications were the plan of care adopted by many in the past. Recently, the new paradigm of early mobility and a proactive approach has been utilized with success.

As we work on managing acute back pain, we must understand that there is a time and place for everything. There are moments where we need to shut things down, and there are moments where we need to engage muscles, promote blood flow, and manage inflammation. Below are considerations on how to address these moments of pain; when we should rest and when we should move.


Bed rest is appropriate when pain is very significant and attempted posture changes/modifications do not produce an improvement in symptoms. However, we want to adopt a dynamic effort to this passive approach, as bed rest for >24-48 hours can actually prompt more soreness and delay the healing of irritated structures. A few modifications to bed rest are, but are not limited to:

  • Make it active: Perform pelvic tilts, glute squeezes, clamshells, and/or trunk rotations to preserve as much mobility as possible. Motion is lotion to all of our joints.
  • Decompression micro-breaks: Take 10-15 minutes of your day to intermittently lie down on your back with your legs elevated on some cushions to help decompress your spine. Offloading irritated joints, discs, and nerve roots can go a long way, especially if ice or heat is utilized in conjunction with your break.


Early movement in a controlled and pain-free range is most beneficial. By staying active early on, we can improve healing time and inflammation by promoting circulation, tissue healing, and muscle recruitment.

  • Perform light cardio: Walking or using an elliptical can maintain core muscle engagement. This helps limit excessive compression and shearing forces through the spine when trying to ensure proper body mechanics. Keep in mind that this is not a time to increase your normal exercise level; less is more at the beginning of a flare-up.
  • Manage inflammation with ice or heat: Apply ice or heat after a good walk or activity that challenges your back. As you start to feel better, ween off of the ice or heat and allow your body’s natural inflammatory dynamics to help heal you.
  • Prevention is key: Stay active, make healthy food choices to maintain a healthy weight, get enough sleep, manage any chronic conditions, and stay up-to-date on preventive health screenings. Efforts at preventing pain can help improve moments of pain in terms of frequency, duration, and intensity.


If symptoms persist and quality of life is impacted, follow-up with your health care practitioner to address your pain and help create a plan of care that is right for you.


Original Article: March 21, 2021


References:

https://www.medbridgeeducation.com/patient-education-library/condition/37190-Managing-Back-Pain

https://choosingwiselycanada.org/treating-lower-back-pain/

Photo by Karolina Grabowska from Pexels


About the Author:

Michael Marcello earned his Bachelor of Science degree in Kinesiology at San Jose State University and his Doctorate in Physical Therapy at the University of the Pacific in Stockton. Michael is experienced in sports medicine, orthopedics, and concussion exertional physical therapy. Michael appreciates and utilizes current evidence-based treatments/interventions, continuing education courses, and exercise to promote optimal function and performance. Michael, a Bay Area native, enjoys exercising, watching sports and spending time with his family and friends.

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